Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 73 First Substitute (2019GS)

Sponsor

Rep. Ward, R.

Final action

Governor Signed 3/22/2019

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• requires the Department of Health to report to the Legislature when the department applies, or receives approval, for a change in any Medicaid capitated payment rates; and
• amends provisions relating to funding for the provision of services by the Division of Services for People with Disabilities.

Every vote on this bill

Bill text

MEDICAL PAYMENT RATES AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Raymond P. Ward
Senate Sponsor: 
Kirk A. Cullimore
LONG TITLE
General Description:
This bill creates certain requirements regarding Medicaid funding.
Highlighted Provisions:
This bill:
▸ requires the Department of Health to report to the Legislature when the department
applies, or receives approval, for a change in any Medicaid capitated payment rates;
and
▸ amends provisions relating to funding for the provision of services by the Division
of Services for People with Disabilities.
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 2018, Chapters 114 and 281
62A-5-102
, as last amended by Laws of Utah 2013, Chapter 172
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) applies for or receives approval for a change in any capitation rate within the
Medicaid program; or
[
(v)
] 
(vi)
 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) (a) 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.
(b) In accordance with Section 
63J-1-602.2
, sanctions collected under this Subsection
(7) are nonlapsing.
(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-102.5
.
Section 2. Section 
62A-5-102
 is amended to read:
62A-5-102.
Division of Services for People with Disabilities -- Creation --
Authority -- Direction -- Provision of services.
(1) There is created within the department the Division of Services for People with
Disabilities, under the administrative direction of the executive director of the department.
(2) In accordance with this chapter, the division has the responsibility to plan and
deliver an appropriate array of services and supports to persons with disabilities and their
families in this state.
(3) Within appropriations from the Legislature, the division shall provide services to
any person with a disability who is eligible to receive division services.
(4) (a) Starting on July 1, 2013, any new appropriations designated to serve eligible
persons waiting for services from the division shall be allocated as set forth in this section.
(b) Eighty-five percent of the money appropriated in Subsection (4)(a) shall be
allocated, as determined by the division by rule based on the:
(i) severity of the disability;
(ii) urgency of the need for services;
(iii) ability of a parent or guardian to provide the person with appropriate care and
supervision; and
(iv) length of time during which the person has not received services from the division.
(c) Fifteen percent of the money appropriated in Subsection (4)(a) shall be allocated for
respite services, and the division shall:
(i) establish rules to identify a person whose only need is respite services;
(ii) allocate money under this Subsection (4)(c) to the people described in Subsection
(4)(c)(i) based on random selection; and
(iii) if all persons described in Subsection (4)(c)(i) have been served and there is
money remaining for respite care under this Subsection (4)(c), the division shall use the
remaining money as described in Subsection (4)(b).
(d) Funds from Subsection (4)(b) that are not spent by the division at the end of the
fiscal year may be used as set forth in Subsection (7).
(5) The division:
(a) has the functions, powers, duties, rights, and responsibilities described in Section
62A-5-103
; and
(b) is authorized to work in cooperation with other state, governmental, and private
agencies to carry out the responsibilities described in Subsection (5)(a).
(6) Within appropriations authorized by the Legislature, and to the extent allowed
under Title XIX of the Social Security Act, the division shall ensure that the services and
support that the division provides to any person with a disability:
(a) are provided in the least restrictive and most enabling environment;
(b) ensure opportunities to access employment; and
(c) enable reasonable personal choice in selecting services and support that:
(i) best meet individual needs; and
(ii) promote:
(A) independence;
(B) productivity; and
(C) integration in community life.
(7) (a) Appropriations to the division are nonlapsing.
(b) After an individual stops receiving services under this section, the division shall use
the funds that paid for the individual's services to provide services under this section to another
eligible individual in an intermediate care facility transitioning to division services, if the funds
were allocated under a program established under Section 
26-18-3
 to transition individuals
with intellectual disabilities from an intermediate care facility.
[
(b)
] 
(c)
 [
If
] 
Except as provided in Subsection (7)(b),
 an individual receiving services
under Subsection (4)(b) or (c) ceases to receive those services, the division shall use the funds
that were allocated to that individual to provide services to another eligible individual waiting
for services as described in Subsection (4)(b).
[
(c)
] 
(d)
 Funds unexpended by the division at the end of the fiscal year may be used
only for one-time expenditures unless otherwise authorized by the Legislature.
[
(d)
] 
(e)
 A one-time expenditure under this section:
(i) is not an entitlement;
(ii) may be withdrawn at any time; and
(iii) may provide short-term, limited services, including:
(A) respite care;
(B) service brokering;
(C) family skill building and preservation classes;
(D) after school group services; and
(E) other professional services.