Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 241 (2018GS)

Sponsor

Sen. Hemmert, D.

Final action

Governor Signed 3/22/2018

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines terms;
• amends and enacts provisions related to recovery of medical assistance from a recipient's estate or trust;
• provides for the imposition of a lien, authorized by the federal Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) against the real property of an individual who is an inpatient in a care facility, during the life of that individual;
• establishes procedures, requirements, and exemptions, relating to imposing a TEFRA lien; and
• makes technical changes.

Every vote on this bill

Bill text

MEDICAL BENEFITS RECOVERY AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Daniel Hemmert
House Sponsor: 
Michael S. Kennedy
LONG TITLE
General Description:
This bill amends and enacts provisions related to state recovery of medical assistance
benefits.
Highlighted Provisions:
This bill:
▸ defines terms;
▸ amends and enacts provisions related to recovery of medical assistance from a
recipient's estate or trust;
▸ provides for the imposition of a lien, authorized by the federal Tax Equity and
Fiscal Responsibility Act of 1982 (TEFRA) against the real property of an
individual who is an inpatient in a care facility, during the life of that individual;
▸ establishes procedures, requirements, and exemptions, relating to imposing a
TEFRA lien; and
▸ makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
31A-4-107.5
, as enacted by Laws of Utah 2007, Chapter 64
31A-22-610
, as last amended by Laws of Utah 2007, Chapter 307
31A-22-610.5
, as last amended by Laws of Utah 2017, Chapters 168 and 292
34A-2-417
, as last amended by Laws of Utah 2010, Chapter 174
34A-2-422
, as last amended by Laws of Utah 2007, Chapter 63
75-3-803
, as last amended by Laws of Utah 2010, Chapter 223
75-3-805
, as last amended by Laws of Utah 1998, Chapter 145
75-7-508
, as last amended by Laws of Utah 2014, Chapter 142
75-7-511
, as renumbered and amended by Laws of Utah 2004, Chapter 89
ENACTS:
26-19-404
, Utah Code Annotated 1953
26-19-501
, Utah Code Annotated 1953
26-19-502
, Utah Code Annotated 1953
26-19-503
, Utah Code Annotated 1953
26-19-504
, Utah Code Annotated 1953
26-19-505
, Utah Code Annotated 1953
26-19-506
, Utah Code Annotated 1953
26-19-507
, Utah Code Annotated 1953
26-19-508
, Utah Code Annotated 1953
26-19-509
, Utah Code Annotated 1953
75-3-104.5
, Utah Code Annotated 1953
RENUMBERS AND AMENDS:
26-19-101
, (Renumbered from 26-19-1, as enacted by Laws of Utah 1981, Chapter 126)
26-19-102
, (Renumbered from 26-19-2, as last amended by Laws of Utah 2007,
Chapter 64)
26-19-103
, (Renumbered from 26-19-3, as last amended by Laws of Utah 1984,
Chapter 34)
26-19-201
, (Renumbered from 26-19-4.5, as last amended by Laws of Utah 1998,
Chapter 145)
26-19-301
, (Renumbered from 26-19-4.7, as enacted by Laws of Utah 2007, Chapter
64)
26-19-302
, (Renumbered from 26-19-14, as last amended by Laws of Utah 2017,
Chapter 292)
26-19-303
, (Renumbered from 26-19-9.5, as enacted by Laws of Utah 2004, Chapter
72)
26-19-304
, (Renumbered from 26-19-9, as enacted by Laws of Utah 1993, Chapter 145)
26-19-305
, (Renumbered from 26-19-8, as last amended by Laws of Utah 2011,
Chapter 297)
26-19-401
, (Renumbered from 26-19-5, as last amended by Laws of Utah 2005,
Chapter 103)
26-19-402
, (Renumbered from 26-19-6, as last amended by Laws of Utah 2009,
Chapter 388)
26-19-403
, (Renumbered from 26-19-7, as last amended by Laws of Utah 2011,
Chapter 297)
26-19-405
, (Renumbered from 26-19-13.5, as last amended by Laws of Utah 2011,
Chapter 366)
26-19-406
, (Renumbered from 26-19-13.7, as enacted by Laws of Utah 1998, Chapter
145)
26-19-601
, (Renumbered from 26-19-9.7, as enacted by Laws of Utah 2004, Chapter
72)
26-19-602
, (Renumbered from 26-19-19, as enacted by Laws of Utah 1998, Chapter
145)
26-19-603
, (Renumbered from 26-19-15, as last amended by Laws of Utah 1984,
Chapter 34)
26-19-604
, (Renumbered from 26-19-16, as enacted by Laws of Utah 1981, Chapter
126)
26-19-605
, (Renumbered from 26-19-17, as last amended by Laws of Utah 1984,
Chapter 34)
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-19-101
, which is renumbered from Section 26-19-1 is
renumbered and amended to read:
Part 1. General Provisions
[
26-19-1
].
 26-19-101.
Title.
This chapter [
shall be
] 
is
 known [
and may be cited
] as the "Medical Benefits Recovery
Act."
Section 2. Section 
26-19-102
, which is renumbered from Section 26-19-2 is
renumbered and amended to read:
[
26-19-2
].
 26-19-102.
Definitions.
As used in this chapter:
(1) "Annuity" shall have the same meaning as provided in Section 
31A-1-301
.
(2) "Care facility" means:
(a) a nursing facility;
(b) an intermediate care facility for an individual with an intellectual disability; or
(c) any other medical institution.
[
(2)
] 
(3)
 "Claim" means:
(a) a request or demand for payment; or
(b) a cause of action for money or damages arising under any law.
[
(3)
] 
(4)
 "Employee welfare benefit plan" means a medical insurance plan developed
by an employer under 29 U.S.C. Section 1001, et seq., the Employee Retirement Income
Security Act of 1974 as amended.
(5) "Health insurance entity" means:
(a) an insurer;
(b) a person who administers, manages, provides, offers, sells, carries, or underwrites
health insurance, as defined in Section 
31A-1-301
;
(c) a self-insured plan;
(d) a group health plan, as defined in Subsection 607(1) of the federal Employee
Retirement Income Security Act of 1974;
(e) a service benefit plan;
(f) a managed care organization;
(g) a pharmacy benefit manager;
(h) an employee welfare benefit plan; or
(i) a person who is, by statute, contract, or agreement, legally responsible for payment
of a claim for a health care item or service.
(6) "Inpatient" means an individual who is a patient and a resident of a care facility.
[
(6)
] 
(7)
 "Insurer" includes:
(a) a group health plan as defined in Subsection 607(1) of the federal Employee
Retirement Income Security Act of 1974;
(b) a health maintenance organization; and
(c) any entity offering a health service benefit plan.
[
(7)
] 
(8)
 "Medical assistance" means:
(a) all funds expended for the benefit of a recipient under Title 26, Chapter 18, Medical
Assistance Act, or under Titles XVIII and XIX, federal Social Security Act; and
(b) any other services provided for the benefit of a recipient by a prepaid health care
delivery system under contract with the department.
[
(8)
] 
(9)
 "Office of Recovery Services" means the Office of Recovery Services within
the Department of Human Services.
[
(9)
] 
(10)
 "Provider" means a person or entity who provides services to a recipient.
[
(10)
] 
(11)
 "Recipient" means:
(a) [
a person
] 
an individual
 who has applied for or received medical assistance from
the state;
(b) the guardian, conservator, or other personal representative of [
a person
] 
an
individual
 under Subsection [
(10)
] 
(11)
(a) if the [
person
] 
individual
 is a minor or an
incapacitated person; or
(c) the estate and survivors of [
a person
] 
an individual
 under Subsection [
(10)
] 
(11)
(a)
,
if the [
person
] 
individual
 is deceased.
[
(4)
] 
(12)
 [
"Estate
] 
"Recovery estate
" means, regarding a deceased recipient:
(a) all real and personal property or other assets included within a decedent's estate as
defined in Section 
75-1-201
;
(b) the decedent's augmented estate as defined in Section 
75-2-203
; and
(c) that part of other real or personal property in which the decedent had a legal interest
at the time of death including assets conveyed to a survivor, heir, or assign of the decedent
through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other
arrangement.
[
(11)
] 
(13)
 "State plan" means the state Medicaid program as enacted in accordance
with Title XIX, federal Social Security Act.
(14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal
Responsibility Act of 1982, against the real property of an individual prior to the individual's
death, as described in 42 U.S.C. Sec. 1396p.
[
(12)
] 
(15)
 "Third party" includes:
(a) an individual, institution, corporation, public or private agency, trust, estate,
insurance carrier, employee welfare benefit plan, health maintenance organization, health
service organization, preferred provider organization, governmental program such as Medicare,
CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the
medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by
department rule; and
(b) a spouse or a parent who:
(i) may be obligated to pay all or part of the medical costs of a recipient under law or
by court or administrative order; or
(ii) has been ordered to maintain health, dental, or accident and health insurance to
cover medical expenses of a spouse or dependent child by court or administrative order.
[
(13)
] 
(16)
 "Trust" shall have the same meaning as provided in Section 
75-1-201
.
Section 3. Section 
26-19-103
, which is renumbered from Section 26-19-3 is
renumbered and amended to read:
[
26-19-3
].
 26-19-103.
Program established by department -- Promulgation of
rules.
(1) The department shall establish and maintain a program for the recoupment of
medical assistance.
(2) The department may promulgate rules to implement the purposes of this chapter.
Section 4. Section 
26-19-201
, which is renumbered from Section 26-19-4.5 is
renumbered and amended to read:
Part 2. Assignment of Rights
[
26-19-4.5
].
 26-19-201.
Assignment of rights to benefits.
(1) (a) To the extent that medical assistance is actually provided to a recipient, all
benefits for medical services or payments from a third party otherwise payable to or on behalf
of a recipient are assigned by operation of law to the department if the department provides, or
becomes obligated to provide, medical assistance, regardless of who made application for the
benefits on behalf of the recipient.
(b) The assignment:
(i) authorizes the department to submit its claim to the third party and authorizes
payment of benefits directly to the department; and
(ii) is effective for all medical assistance.
(2) The department may recover the assigned benefits or payments in accordance with
Section [
26-19-5
] 
26-19-401
 and as otherwise provided by law.
(3) The assignment of benefits includes medical support and third party payments
ordered, decreed, or adjudged by any court of this state or any other state or territory of the
United States. That assignment is not in lieu of, and does not supersede or alter any other court
order, decree, or judgment.
(4) When an assignment takes effect, the recipient is entitled to receive medical
assistance, and the benefits paid to the department are a reimbursement to the department.
Section 5. Section 
26-19-301
, which is renumbered from Section 26-19-4.7 is
renumbered and amended to read:
Part 3. Insurance Provisions
[
26-19-4.7
].
 26-19-301.
Health insurance entity -- Duties related to state claims
for Medicaid payment or recovery.
As a condition of doing business in the state, a health insurance entity shall:
(1) with respect to [
a person
] 
an individual
 who is eligible for, or is provided, medical
assistance under the state plan, upon the request of the Department of Health, provide
information to determine:
(a) during what period the [
person
] 
individual
, or the spouse or dependent of the
[
person
] 
individual
, may be or may have been, covered by the health insurance entity; and
(b) the nature of the coverage that is or was provided by the health insurance entity
described in Subsection (1)(a), including the name, address, and identifying number of the
plan;
(2) accept the state's right of recovery and the assignment to the state of any right of [
a
person
] 
an individual
 to payment from a party for an item or service for which payment has
been made under the state plan;
(3) respond to any inquiry by the Department of Health regarding a claim for payment
for any health care item or service that is submitted no later than three years after the day on
which the health care item or service is provided; and
(4) not deny a claim submitted by the Department of Health solely on the basis of the
date of submission of the claim, the type or format of the claim form, or failure to present
proper documentation at the point-of-sale that is the basis for the claim, if:
(a) the claim is submitted no later than three years after the day on which the item or
service is furnished; and
(b) any action by the Department of Health to enforce the rights of the state with
respect to the claim is commenced no later than six years after the day on which the claim is
submitted.
Section 6. Section 
26-19-302
, which is renumbered from Section 26-19-14 is
renumbered and amended to read:
[
26-19-14
].
 26-19-302.
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 or dependent who is eligible
for or receiving medical assistance from the state.
(2) An association, corporation, or organization may not deliver, issue for delivery, or
renew any subscriber's contract which contains any provisions denying or reducing benefits
because services are rendered to a subscriber or dependent who is eligible for or receiving
medical assistance from the state.
(3) An association, corporation, business, or organization authorized to do business in
this state and which provides or pays for any health care benefits may not deny or reduce
benefits because services are rendered to a beneficiary who is eligible for or receiving medical
assistance from the state.
(4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees
Health Program, administered by the Utah State Retirement Board, is not required to reimburse
any agency of state government for custodial care which the agency provides, through its staff
or facilities, to members of the Utah State Public Employees Health Program.
Section 7. Section 
26-19-303
, which is renumbered from Section 26-19-9.5 is
renumbered and amended to read:
[
26-19-9.5
].
 26-19-303.
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 request any additional information from the department
that is necessary to process the claim; and
(3) provide the department or its agent a copy of any relevant or applicable insurance
or benefit policy.
Section 8. Section 
26-19-304
, which is renumbered from Section 26-19-9 is
renumbered and amended to read:
[
26-19-9
].
 26-19-304.
Employee benefit plans.
As allowed pursuant to 29 U.S.C. Section 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 to benefits or services
under the terms of the employee benefit plan based on the fact that the individual is eligible for
or is provided services under the state plan.
Section 9. Section 
26-19-305
, which is renumbered from Section 26-19-8 is
renumbered and amended to read:
[
26-19-8
].
 26-19-305.
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
chapter against a health insurance entity shall be commenced within:
(i) subject to Subsection (7), six years after the day on which the department submits
the claim for recovery or payment for the health care item or service upon which the action is
based; or
(ii) six months after the date of the last payment for medical assistance, whichever is
later.
(b) An action against any other third party, the recipient, or anyone to whom the
proceeds are payable shall be commenced within:
(i) four years after the date of the injury or onset of the illness; or
(ii) six months after the date of the last payment for medical assistance, whichever is
later.
(2) The death of the recipient does not abate any right of action established by this
chapter.
(3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any
provision that limits the time in which the department may submit its claim to recover medical
assistance benefits to a period of less than 24 months from the date the provider furnishes
services or goods to the recipient.
(b) No insurance policy issued or renewed after April 30, 2007, may contain any
provision that limits the time in which the department may submit its claim to recover medical
assistance benefits to a period of less than that described in Subsection (1)(a).
(4) The provisions of this section do not apply to Section [
26-19-13.5
] 
26-19-405
 or
Part 5, TEFRA Liens
.
(5) The provisions of this section supercede any other sections regarding the time limit
in which an action shall be commenced, including Section 
75-7-509
.
(6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action
described in Subsection (1)(a) that was not time-barred on or before April 30, 2007.
(b) Subsection (1)(a) does not revive a cause of action that was time-barred on or
before April 30, 2007.
(7) An action described in Subsection (1)(a) may not be commenced if the claim for
recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after
the day on which the health care item or service upon which the claim is based was provided.
Section 10. Section 
26-19-401
, which is renumbered from Section 26-19-5 is
renumbered and amended to read:
Part 4. General Recovery Provisions
[
26-19-5
].
 26-19-401.
Recovery of medical assistance from third party -- Lien
-- Notice -- Action -- Compromise or waiver -- Recipient's right to action protected.
(1) (a) When the department provides or becomes obligated to provide medical
assistance to a recipient that a third party is obligated to pay for, the department may recover
the medical assistance directly from that third party.
(b) Any claim arising under Subsection (1)(a) or Section [
26-19-4.5
] 
26-19-201
 to
recover medical assistance provided to a recipient is a lien against any proceeds payable to or
on behalf of the recipient by that third party. This lien has priority over all other claims to the
proceeds, except claims for [
attorney's
] 
attorney
 fees and costs authorized under Subsection
[
26-19-7
] 
26-19-403
(2)(c)(ii).
(2) (a) The department shall mail or deliver written notice of its claim or lien to the
third party at its principal place of business or last-known address.
(b) The notice shall include:
(i) the recipient's name;
(ii) the approximate date of illness or injury;
(iii) a general description of the type of illness or injury; and
(iv) if applicable, the general location where the injury is alleged to have occurred.
(3) The department may commence an action on its claim or lien in its own name, but
that claim or lien is not enforceable as to a third party unless:
(a) the third party receives written notice of the department's claim or lien before it
settles with the recipient; or
(b) the department has evidence that the third party had knowledge that the department
provided or was obligated to provide medical assistance.
(4) The department may:
(a) waive a claim or lien against a third party in whole or in part; or
(b) compromise, settle, or release a claim or lien.
(5) An action commenced under this section does not bar an action by a recipient or a
dependent of a recipient for loss or damage not included in the department's action.
(6) The department's claim or lien on proceeds under this section is not affected by the
transfer of the proceeds to a trust, annuity, financial account, or other financial instrument.
Section 11. Section 
26-19-402
, which is renumbered from Section 26-19-6 is
renumbered and amended to read:
[
26-19-6
].
 26-19-402.
Action by department -- Notice to recipient.
(1) (a) Within 30 days after commencing an action under Subsection [
26-19-5
]
26-19-401
(3), the department shall give the recipient, [
his
] 
the recipient's
 guardian, personal
representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action
by:
(i) personal service or certified mail to the last known address of the person receiving
the notice; or
(ii) if no last-known address is available, by publishing a notice:
(A) once a week for three successive weeks in a newspaper of general circulation in the
county where the recipient resides; and
(B) in accordance with Section 
45-1-101
 for three weeks.
(b) Proof of service shall be filed in the action.
(c) The recipient may intervene in the department's action at any time before trial.
(2) The notice required by Subsection (1) shall name the court in which the action is
commenced and advise the recipient of:
(a) the right to intervene in the proceeding;
(b) the right to obtain a private attorney; and
(c) the department's right to recover medical assistance directly from the third party.
Section 12. Section 
26-19-403
, which is renumbered from Section 26-19-7 is
renumbered and amended to read:
[
26-19-7
].
 26-19-403.
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 for an injury,
disease, or disability for which the department has provided or has become obligated to provide
medical assistance, without the department's written consent as provided in Subsection (2)(b)
or (4).
(b) For purposes of Subsection (1)(a), consent may be obtained if:
(i) a recipient who files a claim, or commences an action against a third party notifies
the department in accordance with Subsection (1)(d) within 10 days of 
the recipient
 making the
claim or commencing an action; or
(ii) an attorney, who has been retained by the recipient to file a claim, or commence an
action against a third party, notifies the department in accordance with Subsection (1)(d) of the
recipient's claim:
(A) within 30 days after being retained by the recipient for that purpose; or
(B) within 30 days from the date the attorney either knew or should have known that
the recipient received medical assistance from the department.
(c) Service of the notice of claim to the department shall be made by certified mail,
personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure,
to the director of the Office of Recovery Services.
(d) The notice of claim shall include the following information:
(i) the name of the recipient;
(ii) the recipient's Social Security number;
(iii) the recipient's date of birth;
(iv) the name of the recipient's attorney if applicable;
(v) the name or names of individuals or entities against whom the recipient is making
the claim, if known;
(vi) the name of the third party's insurance carrier, if known;
(vii) the date of the incident giving rise to the claim; and
(viii) a short statement identifying the nature of the recipient's claim.
(2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1),
the department shall acknowledge receipt of the notice of the claim to the recipient or the
recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the
following:
(i) if the department has a claim or lien pursuant to Section [
26-19-5
] 
26-19-401
 or has
become obligated to provide medical assistance; and
(ii) whether the department is denying or granting written consent in accordance with
Subsection (1)(a).
(b) The department shall provide the recipient's attorney the opportunity to enter into a
collection agreement with the department, with the recipient's consent, unless:
(i) the department, prior to the receipt of the notice of the recipient's claim pursuant to
Subsection (1), filed a written claim with the third party, the third party agreed to make
payment to the department before the date the department received notice of the recipient's
claim, and the agreement is documented in the department's record; or
(ii) there has been a failure by the recipient's attorney to comply with any provision of
this section by:
(A) failing to comply with the notice provisions of this section;
(B) failing or refusing to enter into a collection agreement;
(C) failing to comply with the terms of a collection agreement with the department; or
(D) failing to disburse funds owed to the state in accordance with this section.
(c) (i) The collection agreement shall be:
(A) consistent with this section and the attorney's obligation to represent the recipient
and represent the state's claim; and
(B) state the terms under which the interests of the department may be represented in
an action commenced by the recipient.
(ii) If the recipient's attorney enters into a written collection agreement with the
department, or includes the department's claim in the recipient's claim or action pursuant to
Subsection (4), the department shall pay [
attorney's
] 
attorney
 fees at the rate of 33.3% of the
department's total recovery and shall pay a proportionate share of the litigation expenses
directly related to the action.
(d) The department is not required to enter into a collection agreement with the
recipient's attorney for collection of personal injury protection under Subsection
31A-22-302
(2).
(3) (a) If the department receives notice pursuant to Subsection (1), and notifies the
recipient and the recipient's attorney that the department will not enter into a collection
agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or
action against the third party if the recipient excludes from the claim:
(i) any medical expenses paid by the department; or
(ii) any medical costs for which the department is obligated to provide medical
assistance.
(b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall
provide written notice to the third party of the exclusion of the department's claim for expenses
under Subsection (3)(a)(i) or (ii).
(4) If the department receives notice pursuant to Subsection (1), and does not respond
within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's
attorney:
(a) may proceed with the recipient's claim or action against the third party;
(b) may include the state's claim in the recipient's claim or action; and
(c) may not negotiate, compromise, settle, or waive the department's claim without the
department's consent.
[
(5) The department has an unconditional right to intervene in an action commenced by
a recipient against a third party for the purpose of recovering medical costs for which the
department has provided or has become obligated to provide medical assistance.
]
[
(6) (a) If the recipient proceeds without complying with the provisions of this section,
the department is not bound by any decision, judgment, agreement, settlement, or compromise
rendered or made on the claim or in the action.
]
[
(b) The department may recover in full from the recipient or any party to which the
proceeds were made payable all medical assistance which it has provided and retains its right to
commence an independent action against the third party, subject to Subsection 
26-19-5
(3).
]
[
(7) Any amounts assigned to and recoverable by the department pursuant to Sections
26-19-4.5
 and 
26-19-5
 collected directly by the recipient shall be remitted to the Bureau of
Medical Collections within the Office of Recovery Services no later than five business days
after receipt.
]
[
(8) (a) Any amounts assigned to and recoverable by the department pursuant to
Sections 
26-19-4.5
 and 
26-19-5
 collected directly by the recipient's attorney shall be remitted to
the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days
after the funds are placed in the attorney's trust account.
]
[
(b) The date by which the funds shall be remitted to the department may be modified
based on agreement between the department and the recipient's attorney.
]
[
(c) The department's consent to another date for remittance may not be unreasonably
withheld.
]
[
(d) If the funds are received by the recipient's attorney, no disbursements shall be
made to the recipient or the recipient's attorney until the department's claim has been paid.
]
[
(9) A recipient or recipient's attorney who knowingly and intentionally fails to comply
with this section is liable to the department for:
]
[
(a) the amount of the department's claim or lien pursuant to Subsection (5);
]
[
(b) a penalty equal to 10% of the amount of the department's claim; and
]
[
(c) attorney fees and litigation expenses related to recovering the department's claim.
]
Section 13. Section 
26-19-404
 is enacted to read:
 26-19-404.
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 for the purpose of recovering medical costs for which the
department has provided or has become obligated to provide medical assistance.
(2) (a) If the recipient proceeds without complying with the provisions of Section
26-19-403
, the department is not bound by any decision, judgment, agreement, settlement, or
compromise rendered or made on the claim or in the action.
(b) The department:
(i) may recover in full from the recipient, or any party to which the proceeds were
made payable, all medical assistance that the department has provided; and
(ii) retains its right to commence an independent action against the third party, subject
to Subsection 
26-19-401
(3).
(3) Any amounts assigned to and recoverable by the department pursuant to Sections
26-19-201
 and 
26-19-401
 collected directly by the recipient shall be remitted to the Bureau of
Medical Collections within the Office of Recovery Services no later than five business days
after receipt.
(4) (a) Any amounts assigned to and recoverable by the department pursuant to
Sections 
26-19-201
 and 
26-19-401
 collected directly by the recipient's attorney shall be
remitted to the Bureau of Medical Collections within the Office of Recovery Services no later
than 30 days after the funds are placed in the attorney's trust account.
(b) The date by which the funds shall be remitted to the department may be modified
based on agreement between the department and the recipient's attorney.
(c) The department's consent to another date for remittance may not be unreasonably
withheld.
(d) If the funds are received by the recipient's attorney, no disbursements shall be made
to the recipient or the recipient's attorney until the department's claim has been paid.
(5) A recipient or recipient's attorney who knowingly and intentionally fails to comply
with this section is liable to the department for:
(a) the amount of the department's claim or lien pursuant to Subsection (1);
(b) a penalty equal to 10% of the amount of the department's claim; and
(c) attorney fees and litigation expenses related to recovering the department's claim.
Section 14. Section 
26-19-405
, which is renumbered from Section 26-19-13.5 is
renumbered and amended to read:
[
26-19-13.5
].
 26-19-405.
Estate and trust recovery.
(1) [
Upon
] 
(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 provided for the benefit
of the recipient when the recipient was 55 years of age or older [
if, at the time of death, the
recipient has no:
]
.
[
(a) surviving spouse; or
]
[
(b) child:
]
[
(i) younger than 21 years of age; or
]
[
(ii) who is blind or has a permanent and total disability.
]
(b) The department may not make an adjustment or a recovery under Subsection (1)(a):
(i) while the deceased recipient's spouse is still living; or
(ii) if the deceased recipient has a surviving child who is:
(A) under age 21; or
(B) blind or disabled, as defined in the state plan.
(2) (a) The amount of [
medial
] 
medical
 assistance correctly provided for the benefit of
a recipient and recoverable under this section is a lien against the 
deceased recipient's recovery
estate [
of the deceased recipient
] or any trust when the recipient is the grantor and a
beneficiary.
(b) The lien holds the same priority as reasonable and necessary medical expenses of
the last illness as provided in Section 
75-3-805
.
[
(3) (a) The department shall perfect the lien by filing a notice in the court of
appropriate jurisdiction for the amount of the lien, in the same manner as a creditor's claim is
filed, prior to final distribution.
]
[
(b) The department may file an amended lien prior to the entry of the final order
closing the estate.
]
(3) (a) For a lien described in Subsection (2), the department shall provide notice in
accordance with Section 
38-12-102
.
(b) Before final distribution, the department shall perfect the lien as follows:
(i) for an estate, by presenting the lien to the estate's personal representative in
accordance with Section 
75-3-804
; and
(ii) for a trust, by presenting the lien to the trustee in accordance with Section
75-7-510
.
(c) The department may file an amended lien before the entry of the final order to close
the estate or trust.
(4) Claims against a deceased recipient's inter vivos trust shall be presented in
accordance with Sections 
75-7-509
 and 
75-7-510
.
(5) Any trust provision that denies recovery for medical assistance is void at the time of
its making.
(6) Nothing in this section affects the right of the department to recover Medicaid
assistance before a recipient's death under Section [
26-19-4.5
] 
26-19-201
 or Section
[
26-19-13.7
] 
26-19-406
.
(7) A lien imposed under this section is of indefinite duration. 
Section 15. Section 
26-19-406
, which is renumbered from Section 26-19-13.7 is
renumbered and amended to read:
[
26-19-13.7
].
 26-19-406.
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 [
his
] 
the recipient's recovery
 estate; and
(2) pursuant to a judgment, impose a lien against real property of the recipient.
Section 16. Section 
26-19-501
 is enacted to read:
Part 5. TEFRA Liens
 26-19-501.
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 while the individual is an inpatient in a care facility, if:
(a) the individual is an inpatient in a care facility;
(b) the individual is required, as a condition of receiving services under the state plan,
to spend for costs of medical care all but a minimal amount of the individual's income required
for personal needs; and
(c) the department determines that the individual cannot reasonably be expected to:
(i) be discharged from the care facility; and
(ii) return to the individual's home.
(2) The department may not impose a lien on the home of an individual described in
Subsection (1), if any of the following individuals are lawfully residing in the home:
(a) the spouse of the individual;
(b) a child of the individual, if the child is:
(i) under 21 years of age; or
(ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec.
1382c(a)(3)(F); or
(c) a sibling of the individual, if the sibling:
(i) has an equity interest in the home; and
(ii) resided in the home for at least one year immediately preceding the day on which
the individual was admitted to the care facility.
(3) The department may not impose a TEFRA lien on the real property of an
individual, unless:
(a) the individual has been an inpatient in a care facility for the 180-day period
immediately preceding the day on which the lien is imposed;
(b) the department serves:
(i) a preliminary notice of intent to impose a TEFRA lien relating to the real property,
in accordance with Section 
26-19-503
; and
(ii) a final notice of intent to impose a TEFRA lien relating to the real property, in
accordance with Section 
26-19-504
; and
(c) (i) the individual does not file a timely request for review of the department's
decision under Title 63G, Chapter 4, Administrative Procedures Act; or
(ii) the department's decision is upheld upon final review or appeal under Title 63G,
Chapter 4, Administrative Procedures Act.
Section 17. Section 
26-19-502
 is enacted to read:
 26-19-502.
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 care facility for a period of at
least 180 consecutive days.
Section 18. Section 
26-19-503
 is enacted to read:
 26-19-503.
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
26-19-501
(1), who owns the property.
(2) The preliminary notice of intent shall:
(a) be served in person, or by certified mail, on the individual described in Subsection
26-19-501
(1), and, if the department is aware that the individual has a legally authorized
representative, on the representative;
(b) include a statement indicating that, according to the department's records, the
individual:
(i) meets the criteria described in Subsections 
26-19-501
(1)(a) and (b);
(ii) has been an inpatient in a care facility for a period of at least 180 days immediately
preceding the day on which the department provides the notice to the individual; and
(iii) is legally presumed to be in a condition where it cannot reasonably be expected
that the individual will be discharged from the care facility and return to the individual's home;
(c) indicate that the department intends to impose a TEFRA lien on real property
belonging to the individual;
(d) describe the real property that the TEFRA lien will apply to;
(e) describe the current amount of, and purpose of, the TEFRA lien;
(f) indicate that the amount of the lien may continue to increase as the individual
continues to receive medical assistance;
(g) indicate that the individual may seek to prevent the TEFRA lien from being
imposed on the real property by providing documentation to the department that:
(i) establishes that the individual does not meet the criteria described in Subsection
26-19-501
(1)(a) or (b);
(ii) establishes that the individual has not been an inpatient in a care facility for a
period of at least 180 days;
(iii) rebuts the presumption described in Section 
26-19-502
; or
(iv) establishes that the real property is exempt from imposition of a TEFRA lien under
Subsection 
26-19-501
(2);
(h) indicate that if the owner fails to provide the documentation described in
Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is
served, the department will issue a final notice of intent to impose a TEFRA lien on the real
property and will proceed to impose the lien;
(i) identify the type of documentation that the owner may provide to comply with
Subsection (2)(g);
(j) describe the circumstances under which a TEFRA lien is required to be released;
and
(k) describe the circumstances under which the department may seek to recover the
lien.
Section 19. Section 
26-19-504
 is enacted to read:
 26-19-504.
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 
26-19-503
;
(b) it is at least 30 days after the day on which the preliminary notice of intent was
served; and
(c) the department has not received documentation or other evidence that adequately
establishes that a TEFRA lien may not be imposed on the real property.
(2) The final notice of intent to impose a TEFRA lien on real property shall:
(a) be served in person, or by certified mail, on the individual described in Subsection
26-19-501
(1), who owns the property, and, if the department is aware that the individual has a
legally authorized representative, on the representative;
(b) indicate that the department has complied with the requirements for filing the final
notice of intent under Subsection (1);
(c) include a statement indicating that, according to the department's records, the
individual:
(i) meets the criteria described in Subsections 
26-19-501
(1)(a) and (b);
(ii) has been an inpatient in a care facility for a period of at least 180 days immediately
preceding the day on which the department provides the notice to the individual; and
(iii) is legally presumed to be in a condition where it cannot reasonably be expected
that the individual will be discharged from the care facility and return to the individual's home;
(d) indicate that the department intends to impose a TEFRA lien on real property
belonging to the individual;
(e) describe the real property that the TEFRA lien will apply to;
(f) describe the current amount of, and purpose of, the TEFRA lien;
(g) indicate that the amount of the lien may continue to increase as the individual
continues to receive medical assistance;
(h) describe the circumstances under which a TEFRA lien is required to be released;
(i) describe the circumstances under which the department may seek to recover the
lien;
(j) describe the right of the individual to challenge the decision of the department in an
adjudicative proceeding; and
(k) indicate that failure by the individual to successfully challenge the decision of the
department will result in the TEFRA lien being imposed.
Section 20. Section 
26-19-505
 is enacted to read:
 26-19-505.
Review of department decision.
An individual who has been served with a final notice of intent to impose a TEFRA lien
under Section 
26-19-504
 may seek agency or judicial review of that decision under Title 63G,
Chapter 4, Administrative Procedures Act.
Section 21. Section 
26-19-506
 is enacted to read:
 26-19-506.
Dissolution and removal of TEFRA lien.
(1) A TEFRA lien shall dissolve and be removed by the department if the individual
described in Subsection 
26-19-501
(1):
(a) (i) is discharged from the care facility; and
(ii) returns to the individual's home; or
(b) provides sufficient documentation to the department that:
(i) rebuts the presumption described in Section 
26-19-502
; or
(ii) any of the following individuals are lawfully residing in the individual's home:
(A) the spouse of the individual;
(B) a child of the individual, if the child is under 21 years of age or blind or
permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
(C) a sibling of the individual, if the sibling has an equity interest in the home and
resided in the home for at least one year immediately preceding the day on which the individual
was admitted to the care facility.
(2) An individual described in Subsection 
26-19-501
(1)(a) may, at any time after the
department has imposed a lien under this part, file a request for the department to remove the
lien.
(3) A request filed under Subsection (2) shall be considered and reviewed pursuant to
Title 63G, Chapter 4, Administrative Procedures Act.
Section 22. Section 
26-19-507
 is enacted to read:
 26-19-507.
Expenditures included in lien -- Other proceedings.
(1) A TEFRA lien imposed on real property under this part includes all expenses
relating to medical assistance provided or paid for under the state plan from the first day that
the individual is placed in a care facility, regardless of when the lien is imposed or filed on the
property.
(2) Nothing in this part affects or prevents the department from bringing or pursuing
any other legally authorized action to recover medical assistance or to set aside a fraudulent or
improper conveyance.
Section 23. Section 
26-19-508
 is enacted to read:
 26-19-508.
Contract with another government agency.
If the department contracts with another government agency to recover funds paid for
medical assistance under this chapter, that government agency shall be the sole agency that
determines whether to impose or remove a TEFRA lien under this part.
Section 24. Section 
26-19-509
 is enacted to read:
 26-19-509.
Precedence of the Tax Equity and Fiscal Responsibility Act of 1982.
If any provision of this part conflicts with the requirements of the Tax Equity and Fiscal
Responsibility Act of 1982 for imposing a lien against the property of an individual prior to the
individual's death, under 42 U.S.C. Sec. 1396p, the provisions of the Tax Equity and Fiscal
Responsibility Act of 1982 take precedence and shall be complied with by the department.
Section 25. Section 
26-19-601
, which is renumbered from Section 26-19-9.7 is
renumbered and amended to read:
Part 6. Miscellaneous Provisions
[
26-19-9.7
].
 26-19-601.
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 civil action because it is in
electronic form; and
(2) a third party shall accept an electronic record of payments by the department for
medical services on behalf of a recipient as evidence in support of the department's claim.
Section 26. Section 
26-19-602
, which is renumbered from Section 26-19-19 is
renumbered and amended to read:
[
26-19-19
].
 26-19-602.
Direct payment to the department by third party.
(1) Any third party required to make payment to the department pursuant to this
chapter shall make the payment directly to the department or its designee.
(2) The department may negotiate a payment or payment instrument it receives in
connection with Subsection (1) without the cosignature or other participation of the recipient or
any other party.
Section 27. Section 
26-19-603
, which is renumbered from Section 26-19-15 is
renumbered and amended to read:
[
26-19-15
].
 26-19-603.
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 chapter.
Section 28. Section 
26-19-604
, which is renumbered from Section 26-19-16 is
renumbered and amended to read:
[
26-19-16
].
 26-19-604.
Department's right to attorney fees and costs.
In any action brought by the department under this chapter in which it prevails, the
department shall recover along with the principal sum and interest, a reasonable [
attorney's
]
attorney
 fee and costs incurred.
Section 29. Section 
26-19-605
, which is renumbered from Section 26-19-17 is
renumbered and amended to read:
[
26-19-17
].
 26-19-605.
Application of provisions contrary to federal law
prohibited.
In no event shall any provision contained in this chapter be applied contrary to existing
federal law.
Section 30. Section 
31A-4-107.5
 is amended to read:
31A-4-107.5.
Penalty for failure of a regulated health insurance entity to fulfill
duties related to state claims for Medicaid payment or recovery.
(1) For purposes of this section, "regulated health insurance entity" means a health
insurance entity, as defined in Section [
26-19-2
] 
26-19-102
, that is subject to regulation by the
department.
(2) If a regulated health insurance entity fails to comply with the provisions of Section
[
26-19-4.7
] 
26-19-301
:
(a) the commissioner may revoke or suspend, in whole or in part, a license, certificate
of authority, registration, or other authority that is granted by the commissioner to the regulated
health insurance entity; and
(b) the regulated health insurance entity is subject to the penalties and procedures
provided for in Section 
31A-2-308
.
Section 31. Section 
31A-22-610
 is amended to read:
31A-22-610.
Dependent coverage from moment of birth or adoption.
(1) As used in this section:
(a) "Child" means, in connection with any adoption, or placement for adoption of the
child, an individual who is younger than 18 years of age as of the date of the adoption or
placement for adoption.
(b) "Placement for adoption" means the assumption and retention by a person of a legal
obligation for total or partial support of a child in anticipation of the adoption of the child.
(2) (a) Except as provided in Subsection (5), if an accident and health insurance policy
provides coverage for any members of the policyholder's or certificate holder's family, the
policy shall provide that any health insurance benefits applicable to dependents of the insured
are applicable on the same basis to:
(i) a newly born child from the moment of birth; and
(ii) an adopted child:
(A) beginning from the moment of birth, if placement for adoption occurs within 30
days of the child's birth; or
(B) beginning from the date of placement, if placement for adoption occurs 30 days or
more after the child's birth.
(b) The coverage described in this Subsection (2):
(i) is not subject to any preexisting conditions; and
(ii) includes any injury or sickness, including the necessary care and treatment of
medically diagnosed:
(A) congenital defects;
(B) birth abnormalities; or
(C) prematurity.
(c) (i) Subject to Subsection (2)(c)(ii), a claim for services for a newly born child or an
adopted child may be denied until the child is enrolled.
(ii) Notwithstanding Subsection (2)(c)(i), an otherwise eligible claim denied under
Subsection (2)(c)(i) is eligible for payment and may be resubmitted or reprocessed once a child
is enrolled pursuant to Subsection (2)(d) or (e).
(d) If the payment of a specific premium is required to provide coverage for a child of a
policyholder or certificate holder, for there to be coverage for the child, the policyholder or
certificate holder shall enroll:
(i) a newly born child within 30 days after the date of birth of the child; or
(ii) an adopted child within 30 days after the day of placement of adoption.
(e) If the payment of a specific premium is not required to provide coverage for a child
of a policyholder or certificate holder, for the child to receive coverage the policyholder or
certificate holder shall enroll a newly born child or an adopted child no later than 30 days after
the first notification of denial of a claim for services for that child.
(3) (a) The coverage required by Subsection (2) as to children placed for the purpose of
adoption with a policyholder or certificate holder continues in the same manner as it would
with respect to a child of the policyholder or certificate holder unless:
(i) the placement is disrupted prior to legal adoption; and
(ii) the child is removed from placement.
(b) The coverage required by Subsection (2) ends if the child is removed from
placement prior to being legally adopted.
(4) The provisions of this section apply to employee welfare benefit plans as defined in
Section [
26-19-2
] 
26-19-102
.
(5) If an accident and health insurance policy that is not subject to the special
enrollment rights described in 45 C.F.R. Sec. 146.117(b) provides coverage for one individual,
the insurer may choose to:
(a) provide coverage according to this section; or
(b) allow application, subject to the insurer's underwriting criteria for:
(i) a newborn;
(ii) an adopted child; or
(iii) a child placed for adoption.
Section 32. Section 
31A-22-610.5
 is amended to read:
31A-22-610.5.
Dependent coverage.
(1) As used in this section, "child" has the same meaning as defined in Section
78B-12-102
.
(2) (a) Any individual or group accident and health insurance policy or managed care
organization contract that provides coverage for a policyholder's or certificate holder's
dependent may not terminate coverage of an unmarried dependent by reason of the dependent's
age before the dependent's 26th birthday and shall, upon application, provide coverage for all
unmarried dependents up to age 26.
(b) The cost of coverage for unmarried dependents 19 to 26 years of age shall be
included in the premium on the same basis as other dependent coverage.
(c) This section does not prohibit the employer from requiring the employee to pay all
or part of the cost of coverage for unmarried dependents.
(d) An individual or group health insurance policy or managed care organization shall
continue in force coverage for a dependent through the last day of the month in which the
dependent ceases to be a dependent:
(i) if premiums are paid; and
(ii) notwithstanding Sections 
31A-22-618.6
 and 
31A-22-618.7
.
(3) (a) When a parent is required by a court or administrative order to provide health
insurance coverage for a child, an accident and health insurer may not deny enrollment of a
child under the accident and health insurance plan of the child's parent on the grounds the
child:
(i) was born out of wedlock and is entitled to coverage under Subsection (4);
(ii) was born out of wedlock and the custodial parent seeks enrollment for the child
under the custodial parent's policy;
(iii) is not claimed as a dependent on the parent's federal tax return; or
(iv) does not reside with the parent or in the insurer's service area.
(b) A child enrolled as required under Subsection (3)(a)(iv) is subject to the terms of
the accident and health insurance plan contract pertaining to services received outside of an
insurer's service area.
(4) When a child has accident and health coverage through an insurer of a noncustodial
parent, and when requested by the noncustodial or custodial parent, the insurer shall:
(a) provide information to the custodial parent as necessary for the child to obtain
benefits through that coverage, but the insurer or employer, or the agents or employees of either
of them, are not civilly or criminally liable for providing information in compliance with this
Subsection (4)(a), whether the information is provided pursuant to a verbal or written request;
(b) permit the custodial parent or the service provider, with the custodial parent's
approval, to submit claims for covered services without the approval of the noncustodial
parent; and
(c) make payments on claims submitted in accordance with Subsection (4)(b) directly
to the custodial parent, the child who obtained benefits, the provider, or the state Medicaid
agency.
(5) When a parent is required by a court or administrative order to provide health
coverage for a child, and the parent is eligible for family health coverage, the insurer shall:
(a) permit the parent to enroll, under the family coverage, a child who is otherwise
eligible for the coverage without regard to an enrollment season restrictions;
(b) if the parent is enrolled but fails to make application to obtain coverage for the
child, enroll the child under family coverage upon application of the child's other parent, the
state agency administering the Medicaid program, or the state agency administering 42 U.S.C.
Sec. 651 through 669, the child support enforcement program; and
(c) (i) when the child is covered by an individual policy, not disenroll or eliminate
coverage of the child unless the insurer is provided satisfactory written evidence that:
(A) the court or administrative order is no longer in effect; or
(B) the child is or will be enrolled in comparable accident and health coverage through
another insurer which will take effect not later than the effective date of disenrollment; or
(ii) when the child is covered by a group policy, not disenroll or eliminate coverage of
the child unless the employer is provided with satisfactory written evidence, which evidence is
also provided to the insurer, that Subsection (8)(c)(i), (ii), or (iii) has happened.
(6) An insurer may not impose requirements on a state agency that has been assigned
the rights of an individual eligible for medical assistance under Medicaid and covered for
accident and health benefits from the insurer that are different from requirements applicable to
an agent or assignee of any other individual so covered.
(7) Insurers may not reduce their coverage of pediatric vaccines below the benefit level
in effect on May 1, 1993.
(8) When a parent is required by a court or administrative order to provide health
coverage, which is available through an employer doing business in this state, the employer 
shall:
(a) permit the parent to enroll under family coverage any child who is otherwise
eligible for coverage without regard to any enrollment season restrictions;
(b) if the parent is enrolled but fails to make application to obtain coverage of the child,
enroll the child under family coverage upon application by the child's other parent, by the state
agency administering the Medicaid program, or the state agency administering 42 U.S.C. Sec.
651 through 669, the child support enforcement program;
(c) not disenroll or eliminate coverage of the child unless the employer is provided
satisfactory written evidence that:
(i) the court order is no longer in effect;
(ii) the child is or will be enrolled in comparable coverage which will take effect no
later than the effective date of disenrollment; or
(iii) the employer has eliminated family health coverage for all of its employees; and
(d) withhold from the employee's compensation the employee's share, if any, of
premiums for health coverage and to pay this amount to the insurer.
(9) An order issued under Section 
62A-11-326.1
 may be considered a "qualified
medical support order" for the purpose of enrolling a dependent child in a group accident and
health insurance plan as defined in Section 609(a), Federal Employee Retirement Income
Security Act of 1974.
(10) This section does not affect any insurer's ability to require as a precondition of any
child being covered under any policy of insurance that:
(a) the parent continues to be eligible for coverage;
(b) the child shall be identified to the insurer with adequate information to comply with
this section; and
(c) the premium shall be paid when due.
(11) This section applies to employee welfare benefit plans as defined in Section
[
26-19-2
] 
26-19-102
.
(12) (a) A policy that provides coverage to a child of a group member may not deny
eligibility for coverage to a child solely because:
(i) the child does not reside with the insured; or
(ii) the child is solely dependent on a former spouse of the insured rather than on the
insured.
(b) A child who does not reside with the insured may be excluded on the same basis as
a child who resides with the insured.
Section 33. Section 
34A-2-417
 is amended to read:
34A-2-417.
Claims and benefits -- Time limits for filing -- Burden of proof.
(1) (a) Except with respect to prosthetic devices or in a permanent total disability case,
an employee is entitled to be compensated for a medical expense if:
(i) the medical expense is:
(A) reasonable in amount; and
(B) necessary to treat the industrial accident; and
(ii) the employee submits or makes a reasonable attempt to submit the medical
expense:
(A) to the employee's employer or insurance carrier for payment; and
(B) within one year from the later of:
(I) the day on which the medical expense is incurred; or
(II) the day on which the employee knows or in the exercise of reasonable diligence
should have known that the medical expense is related to the industrial accident.
(b) For an industrial accident that occurs on or after July 1, 1988, and is the basis of a
claim for a medical expense, an employee is entitled to be compensated for the medical
expense if the employee meets the requirements of Subsection (1)(a).
(2) (a) A claim described in Subsection (2)(b) is barred, unless the employee:
(i) files an application for hearing with the Division of Adjudication no later than six
years from the date of the accident; and
(ii) by no later than 12 years from the date of the accident, is able to meet the
employee's burden of proving that the employee is due the compensation claimed under this
chapter.
(b) Subsection (2)(a) applies to a claim for compensation for:
(i) temporary total disability benefits;
(ii) temporary partial disability benefits;
(iii) permanent partial disability benefits; or
(iv) permanent total disability benefits.
(c) The commission may enter an order awarding or denying an employee's claim for
compensation under this chapter within a reasonable time period beyond 12 years from the date
of the accident, if:
(i) the employee complies with Subsection (2)(a); and
(ii) 12 years from the date of the accident:
(A) (I) the employee is fully cooperating in a commission approved reemployment
plan; and
(II) the results of that commission approved reemployment plan are not known; or
(B) the employee is actively adjudicating issues of compensability before the
commission.
(3) A claim for death benefits is barred unless an application for hearing is filed within
one year of the date of death of the employee.
(4) (a) (i) Subject to Subsections (2)(c) and (4)(b), after an employee files an
application for hearing within six years from the date of the accident, the Division of
Adjudication may enter an order to show cause why the employee's claim should not be
dismissed because the employee has failed to meet the employee's burden of proof to establish
an entitlement to compensation claimed in the application for hearing.
(ii) The order described in Subsection (4)(a)(i) may be entered on the motion of the:
(A) Division of Adjudication;
(B) employee's employer; or
(C) employer's insurance carrier.
(b) Under Subsection (4)(a), the Division of Adjudication may dismiss a claim:
(i) without prejudice; or
(ii) with prejudice only if:
(A) the Division of Adjudication adjudicates the merits of the employee's entitlement
to the compensation claimed in the application for hearing; or
(B) the employee fails to comply with Subsection (2)(a)(ii).
(c) If a claim is dismissed without prejudice under Subsection (4)(b), the employee is
subject to the time limits under Subsection (2)(a) to claim compensation under this chapter.
(5) A claim for compensation under this chapter is subject to a claim or lien for
recovery under Section [
26-19-5
] 
26-19-401
.
Section 34. Section 
34A-2-422
 is amended to read:
34A-2-422.
Compensation exempt from execution -- Transfer of payment rights.
(1) For purposes of this section:
(a) "Payment rights under workers' compensation" means the right to receive
compensation under this chapter or Chapter 3, Utah Occupational Disease Act, including the
payment of a workers' compensation claim, award, benefit, or settlement.
(b) (i) Subject to Subsection (1)(b)(ii), "transfer" means:
(A) a sale;
(B) an assignment;
(C) a pledge;
(D) an hypothecation; or
(E) other form of encumbrance or alienation for consideration.
(ii) "Transfer" does not include the creation or perfection of a security interest in a right
to receive a payment under a blanket security agreement entered into with an insured
depository institution, in the absence of any action to:
(A) redirect the payments to:
(I) the insured depository institution; or
(II) an agent or successor in interest to the insured depository institution; or
(B) otherwise enforce a blanket security interest against the payment rights.
(2) Compensation before payment:
(a) is exempt from:
(i) all claims of creditors; and
(ii) attachment or execution; and
(b) shall be paid only to employees or their dependents, except as provided in Sections
[
26-19-5
] 
26-19-401
 and 
34A-2-417
.
(3) (a) Subject to Subsection (3)(b), beginning April 30, 2007, a person may not:
(i) transfer payment rights under workers' compensation; or
(ii) accept or take any action to provide for a transfer of payment rights under workers'
compensation.
(b) A person may take an action prohibited under Subsection (3)(a) if the commission
approves the transfer of payment rights under workers' compensation:
(i) before the transfer of payment rights under workers' compensation takes effect; and
(ii) upon a determination by the commission that:
(A) the person transferring the payment rights under workers' compensation received
before executing an agreement to transfer those payment rights:
(I) adequate notice that the transaction involving the transfer of payment rights under
workers' compensation involves the transfer of those payment rights; and
(II) an explanation of the financial consequences of and alternatives to the transfer of
payment rights under workers' compensation in sufficient detail that the person transferring the
payment rights under workers' compensation made an informed decision to transfer those
payment rights; and
(B) the transfer of payment rights under workers' compensation is in the best interest of
the person transferring the payment rights under workers' compensation taking into account the
welfare and support of that person's dependents.
(c) The approval by the commission of the transfer of a person's payment rights under
workers' compensation is a full and final resolution of the person's payment rights under
workers' compensation that are transferred:
(i) if the commission approves the transfer of the payment rights under workers'
compensation in accordance with Subsection (3)(b); and
(ii) once the person no longer has a right to appeal the decision in accordance with this
title.
Section 35. Section 
75-3-104.5
 is enacted to read:
 75-3-104.5.
Notice to the state.
(1) Within 30 days after the day on which a petitioner or personal representative files
an action under this chapter for a decedent who was at least 55 years old, the petitioner or
personal representative shall send a copy of the pleadings, by certified mail, to the Office of
Recovery Services created in Section 
62A-1-105
.
(2) Failure to provide notice as described in Subsection (1) tolls all limitations
concerning the state's presentation or enforcement of a lien or claim under Section 
26-19-405
.
Section 36. Section 
75-3-803
 is amended to read:
75-3-803.
Limitations on presentation of claims.
(1) All claims against a decedent's estate which arose before the death of the decedent,
including claims of the state and any subdivision of it, whether due or to become due, absolute
or contingent, liquidated or unliquidated, founded on contract, tort, or other legal basis, if not
barred earlier by other statute of limitations, are barred against the estate, the personal
representative, and the heirs and devisees of the decedent, unless presented within the earlier of
the following dates:
(a) one year after the decedent's death; or
(b) within the time provided by Subsection 
75-3-801
(2) for creditors who are given
actual notice, and where notice is published, within the time provided in Subsection
75-3-801
(1) for all claims barred by publication.
(2) In all events, claims barred by the nonclaim statute at the decedent's domicile are
also barred in this state.
(3) All claims against a decedent's estate which arise at or after the death of the
decedent, including claims of the state and any of its subdivisions, whether due or to become
due, absolute or contingent, liquidated or unliquidated, founded on contract, tort, or other legal
basis are barred against the estate, the personal representative, and the heirs and devisees of the
decedent, unless presented as follows:
(a) a claim based on a contract with the personal representative within three months
after performance by the personal representative is due; or
(b) any other claim within the later of three months after it arises, or the time specified
in Subsection (1)(a).
(4) Nothing in this section affects or prevents:
(a) any proceeding to enforce any mortgage, pledge, or other lien upon property of the
estate;
(b) to the limits of the insurance protection only, any proceeding to establish liability of
the decedent or the personal representative for which [
he
] 
the decedent or the personal
representative
 is protected by liability insurance; [
or
]
(c) collection of compensation for services rendered and reimbursement for expenses
advanced by the personal representative or by the attorney or accountant for the personal
representative of the estate[
.
]
; or
(d) medical assistance recovery under Title 26, Chapter 19, Medical Benefits Recovery
Act.
(5) If a personal representative has not been timely appointed in accordance with this
chapter, one may be appointed for the limited purposes of Subsection (4)(b) for any claim
timely brought against the decedent.
Section 37. Section 
75-3-805
 is amended to read:
75-3-805.
Classification of claims.
(1) If the applicable assets of the estate are insufficient to pay all claims in full, the
personal representative shall make payment in the following order:
(a) reasonable funeral expenses;
(b) costs and expenses of administration;
(c) debts and taxes with preference under federal law;
(d) reasonable and necessary medical and hospital expenses of the last illness of the
decedent, including compensation of persons attending [
him
] 
the decedent
, and medical
assistance if Section [
26-19-13.5
] 
26-19-405
 applies;
(e) debts and taxes with preference under other laws of this state; and
(f) all other claims.
(2) No preference shall be given in the payment of any claim over any other claim of
the same class, and a claim due and payable shall not be entitled to a preference over claims not
due.
Section 38. Section 
75-7-508
 is amended to read:
75-7-508.
Notice to creditors.
(1) (a) A trustee for an inter vivos revocable trust, upon the death of the settlor, may
publish a notice to creditors:
(i) once a week for three successive weeks in a newspaper of general circulation in the
county where the settlor resided at the time of death; and
(ii) in accordance with Section 
45-1-101
 for three weeks.
(b) The notice required by Subsection (1)(a) shall:
(i) provide the trustee's name and address; and
(ii) notify creditors:
(A) of the deceased settlor; and
(B) to present their claims within three months after the date of the first publication of
the notice or be forever barred from presenting the claim.
(2) A trustee shall give written notice by mail or other delivery to any known creditor
of the deceased settlor, notifying the creditor to present [
his
] 
the creditor's
 claim within 90 days
from the published notice if given as provided in Subsection (1) or within 60 days from the
mailing or other delivery of the notice, whichever is later, or be forever barred. Written notice
shall be the notice described in Subsection (1) or a similar notice.
(3) (a) If the deceased settlor received medical assistance, as defined in Section
[
26-19-2
] 
26-19-102
, at any time after the age of 55, the trustee for an inter vivos revocable
trust, upon the death of the settlor, shall mail or deliver written notice to the Director of the
Office of Recovery Services, on behalf of the Department of Health, to present any claim under
Section [
26-19-13.5
] 
26-19-405
 within 60 days from the mailing or other delivery of notice,
whichever is later, or be forever barred.
(b) If the trustee does not mail notice to the director of the Office of Recovery Services
on behalf of the department in accordance with Subsection (3)(a), the department shall have
one year from the death of the settlor to present its claim.
(4) The trustee is not liable to any creditor or to any successor of the deceased settlor
for giving or failing to give notice under this section.
(5) The notice to creditors shall be valid against any creditor of the trust and also
against any creditor of the estate of the deceased settlor.
Section 39. Section 
75-7-511
 is amended to read:
75-7-511.
Classification of claims.
(1) If the applicable assets of the deceased settlor's estate or trust estate are insufficient
to pay all claims in full, the trustee shall make payment in the following order:
(a) reasonable funeral expenses;
(b) costs and expenses of administration;
(c) debts and taxes with preference under federal law;
(d) reasonable and necessary medical and hospital expenses of the last illness of the
deceased settlor, including compensation of persons attending [
him
] 
the deceased settlor
, and
medical assistance if Section [
26-19-13.5
] 
26-19-405
 applies;
(e) debts and taxes with preference under other laws of this state; and
(f) all other claims.
(2) No preference shall be given in the payment of any claim over any other claim of
the same class, and a claim due and payable shall not be entitled to a preference over claims not
due.