Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 436 First Substitute (2020GS)

Sponsor

Rep. Dunnigan, J.

Final action

Governor Signed 3/28/2020

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• amends provisions relating to Medicaid;
• amends provisions for the financing of the Utah Premium Partnership for Health Insurance program;
• updates the Drug Utilization Review reporting requirements;
• updates certain background check requirements for individuals who have direct access to children or vulnerable adults;
• allows for transportation during a temporary commitment to occur via a nonemergency secured behavioral transport in certain circumstances; and
• makes technical changes.

Every vote on this bill

Bill text

HEALTH AND HUMAN SERVICES AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: James A. Dunnigan
Senate Sponsor: 
Allen M. Christensen
LONG TITLE
General Description:
This bill amends provisions related to health and human services.
Highlighted Provisions:
This bill:
▸ amends provisions relating to Medicaid;
▸ amends provisions for the financing of the Utah Premium Partnership for Health
Insurance program;
▸ updates the Drug Utilization Review reporting requirements;
▸ updates certain background check requirements for individuals who have direct
access to children or vulnerable adults;
▸ allows for transportation during a temporary commitment to occur via a
nonemergency secured behavioral transport in certain circumstances; and
▸ makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides a coordination clause.
Utah Code Sections Affected:
AMENDS:
26-18-2.3
, as last amended by Laws of Utah 2019, Chapter 393
26-18-2.6
, as last amended by Laws of Utah 2017, Chapter 22
26-18-3.1
, as last amended by Laws of Utah 2019, Chapter 1
26-18-3.8
, as last amended by Laws of Utah 2013, Chapter 137
26-18-3.9
, as last amended by Laws of Utah 2019, Chapter 1
26-18-5
, as last amended by Laws of Utah 2019, Chapter 393
26-18-8
, as last amended by Laws of Utah 2003, Chapter 90
26-18-103
, as last amended by Laws of Utah 2013, Chapter 167
26-18-408
, as last amended by Laws of Utah 2019, Chapter 393
26-18-411
, as last amended by Laws of Utah 2019, Chapter 393
26-18-413
, as last amended by Laws of Utah 2019, Chapters 60 and 393
26-36b-204
, as last amended by Laws of Utah 2018, Chapters 384 and 468
26-36b-205
, as last amended by Laws of Utah 2018, Chapters 384 and 468
26-36c-204
, as last amended by Laws of Utah 2019, Chapter 1
26-40-106
, as last amended by Laws of Utah 2019, Chapter 393
62A-2-120
, as last amended by Laws of Utah 2019, Chapter 335
62A-15-629
, as last amended by Laws of Utah 2018, Chapter 322
REPEALS:
26-18-404
, as last amended by Laws of Utah 2019, Chapter 393
26-40-116
, as last amended by Laws of Utah 2019, Chapter 393
Utah Code Sections Affected by Coordination Clause:
62A-2-120
, as last amended by Laws of Utah 2019, Chapter 335
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-2.3
 is amended to read:
26-18-2.3.
Division responsibilities -- Emphasis -- Periodic assessment.
(1) In accordance with the requirements of Title XIX of the Social Security Act and
applicable federal regulations, the division is responsible for the effective and impartial
administration of this chapter in an efficient, economical manner. The division shall:
(a) establish, on a statewide basis, a program to safeguard against unnecessary or
inappropriate use of Medicaid services, excessive payments, and unnecessary or inappropriate
hospital admissions or lengths of stay;
(b) deny any provider claim for services that fail to meet criteria established by the
division concerning medical necessity or appropriateness; and
(c) place its emphasis on high quality care to recipients in the most economical and
cost-effective manner possible, with regard to both publicly and privately provided services.
(2) The division shall implement and utilize cost-containment methods, where
possible, which may include:
(a) prepayment and postpayment review systems to determine if utilization is
reasonable and necessary;
(b) preadmission certification of nonemergency admissions;
(c) mandatory outpatient, rather than inpatient, surgery in appropriate cases;
(d) second surgical opinions;
(e) procedures for encouraging the use of outpatient services;
(f) consistent with Sections 
26-18-2.4
 and 
58-17b-606
, a Medicaid drug program;
(g) coordination of benefits; and
(h) review and exclusion of providers who are not cost effective or who have abused
the Medicaid program, in accordance with the procedures and provisions of federal law and
regulation.
(3) The state [
medicaid
] 
Medicaid
 director shall periodically assess the cost
effectiveness and health implications of the existing Medicaid program, and consider
alternative approaches to the provision of covered health and medical services through the
Medicaid program, in order to reduce unnecessary or unreasonable utilization.
(4) (a) The department shall ensure Medicaid program integrity by conducting internal
audits of the Medicaid program for efficiencies, best practices, and cost [
recovery
] 
avoidance
.
(b) The department shall coordinate with the Office of the Inspector General for
Medicaid Services created in Section 
63A-13-201
 to implement Subsection (2) and to address
Medicaid fraud, waste, or abuse as described in Section 
63A-13-202
.
Section 2. Section 
26-18-2.6
 is amended to read:
26-18-2.6.
Dental benefits.
(1) (a) Except as provided in Subsection (8), the division [
shall
] 
may
 establish a
competitive bid process to bid out Medicaid dental benefits under this chapter.
(b) The division may bid out the Medicaid dental benefits separately from other
program benefits.
(2) The division shall use the following criteria to evaluate dental bids:
(a) ability to manage dental expenses;
(b) proven ability to handle dental insurance;
(c) efficiency of claim paying procedures;
(d) provider contracting, discounts, and adequacy of network; and
(e) other criteria established by the department.
(3) The division shall request bids for the program's benefits[
:
] 
at least once every five
years.
[
(a) in 2011; and
]
[
(b) at least once every five years thereafter.
]
(4) The division's contract with dental plans for the program's benefits shall include
risk sharing provisions in which the dental plan must accept 100% of the risk for any difference
between the division's premium payments per client and actual dental expenditures.
(5) The division may not award contracts to:
(a) more than three responsive bidders under this section; or
(b) an insurer that does not have a current license in the state.
(6) (a) The division may cancel the request for proposals if:
(i) there are no responsive bidders; or
(ii) the division determines that accepting the bids would increase the program's costs.
(b) If the division cancels [
the request for proposals under
] 
a request for proposal or a
contract that results from a request for proposal described in
 Subsection (6)(a), the division
shall report to the Health and Human Services Interim Committee regarding the reasons for the
decision.
(7) Title 63G, Chapter 6a, Utah Procurement Code, shall apply to this section.
(8) (a) The division may:
(i) establish a dental health care delivery system and payment reform pilot program for
Medicaid dental benefits to increase access to cost effective and quality dental health care by
increasing the number of dentists available for Medicaid dental services; and
(ii) target specific Medicaid populations or geographic areas in the state.
(b) The pilot program shall establish compensation models for dentists and dental
hygienists that:
(i) increase access to quality, cost effective dental care; and
(ii) use funds from the Division of Family Health and Preparedness that are available to
reimburse dentists for educational loans in exchange for the dentist agreeing to serve Medicaid
and under-served populations.
(c) The division may amend the state plan and apply to the Secretary of Health and
Human Services for waivers or pilot programs if necessary to establish the new dental care
delivery and payment reform model.
(d)
 The division shall evaluate the pilot program's effect on the cost of dental care and
access to dental care for the targeted Medicaid populations.
Section 3. Section 
26-18-3.1
 is amended to read:
26-18-3.1.
Medicaid expansion.
(1) The purpose of this section is to expand the coverage of the Medicaid program to
persons who are in categories traditionally not served by that program.
(2) Within appropriations from the Legislature, the department may amend the state
plan for medical assistance to provide for eligibility for Medicaid:
(a) on or after July 1, 1994, for children 12 to 17 years old who live in households
below the federal poverty income guideline; and
(b) on or after July 1, 1995, for persons who have incomes below the federal poverty
income guideline and who are aged, blind, or have a disability.
(3) (a) Within appropriations from the Legislature, on or after July 1, 1996, the
Medicaid program may provide for eligibility for persons who have incomes below the federal
poverty income guideline.
(b) In order to meet the provisions of this subsection, the department may seek
approval for a demonstration project under 42 U.S.C. Sec. 1315 from the secretary of the
United States Department of Health and Human Services. [
This demonstration project may
also provide for the voluntary participation of private firms that:
]
[
(i) are newly established or marginally profitable;
]
[
(ii) do not provide health insurance to their employees;
]
[
(iii) employ predominantly low wage workers; and
]
[
(iv) are unable to obtain adequate and affordable health care insurance in the private
market.
]
(4) The Medicaid program shall provide for eligibility for persons as required by
Subsection 
26-18-3.9
(2).
(5) Services available for persons described in this section shall include required
Medicaid services and may include one or more optional Medicaid services if those services
are funded by the Legislature. The department may also require persons described in
Subsections (1) through (3) to meet an asset test.
Section 4. Section 
26-18-3.8
 is amended to read:
26-18-3.8.
Maximizing use of premium assistance programs -- Utah's Premium
Partnership for Health Insurance.
(1) (a) The department shall seek to maximize the use of Medicaid and Children's
Health Insurance Program funds for assistance in the purchase of private health insurance
coverage for Medicaid-eligible and non-Medicaid-eligible individuals.
(b) The department's efforts to expand the use of premium assistance shall:
(i) include, as necessary, seeking federal approval under all Medicaid and Children's
Health Insurance Program premium assistance provisions of federal law, including provisions
of the Patient Protection and Affordable Care Act, Public Law 111-148;
(ii) give priority to, but not be limited to, expanding the state's Utah Premium
Partnership for Health Insurance Program, including as required under Subsection (2); and
(iii) encourage the enrollment of all individuals within a household in the same plan,
where possible, including enrollment in a plan that allows individuals within the household
transitioning out of Medicaid to retain the same network and benefits they had while enrolled
in Medicaid.
[
(c) Any increase in state costs resulting from an expansion of premium assistance may
not exceed offsetting reductions in Medicaid and Children's Health Insurance Program state
costs attributable to the expansion.
]
(2) The department shall seek federal approval of an amendment to the state's Utah
Premium Partnership for Health Insurance program to adjust the eligibility determination for
single adults and parents who have an offer of employer sponsored insurance. The amendment
shall:
(a) be within existing appropriations for the Utah Premium Partnership for Health
Insurance program; and
(b) provide that adults who are up to 200% of the federal poverty level are eligible for
premium subsidies in the Utah Premium Partnership for Health Insurance program.
(3) For fiscal year 2021-22, the department shall seek authority to increase the
maximum premium subsidy per month for adults under the Utah Premium Partnership for
Health Insurance program to $300.
(4) Beginning with fiscal year 2021-22, and in each subsequent year, the department
may increase premium subsidies for single adults and parents who have an offer of
employer-sponsored insurance to keep pace with the increase in insurance premium costs
subject to appropriation of additional funding.
Section 5. Section 
26-18-3.9
 is amended to read:
26-18-3.9.
Expanding the Medicaid program.
(1) As used in this section:
(a) "CMS" means the Centers for Medicare and Medicaid Services in the United States
Department of Health and Human Services.
(b) "Federal poverty level" means the same as that term is defined in Section
26-18-411
.
(c) "Medicaid expansion" means an expansion of the Medicaid program in accordance
with this section.
(d) "Medicaid Expansion Fund" means the Medicaid Expansion Fund created in
Section 
26-36b-208
.
(2) (a) As set forth in Subsections (2) through (5), eligibility criteria for the Medicaid
program shall be expanded to cover additional low-income individuals.
(b) The department shall continue to seek approval from CMS to implement the
Medicaid waiver expansion as defined in Section 
26-18-415
.
(c) The department may implement any provision described in Subsections
26-18-415
(2)(b)(iii) through (viii) in a Medicaid expansion if the department receives approval
from CMS to implement that provision.
(3) The department shall expand the Medicaid program in accordance with this
Subsection (3) if the department:
(a) receives approval from CMS to:
(i) expand Medicaid coverage to eligible individuals whose income is below 95% of
the federal poverty level;
(ii) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(b) for
enrolling an individual in the Medicaid expansion under this Subsection (3); and
(iii) permit the state to close enrollment in the Medicaid expansion under this
Subsection (3) if the department has insufficient funds to provide services to new enrollment
under the Medicaid expansion under this Subsection (3);
(b) pays the state portion of costs for the Medicaid expansion under this Subsection (3)
with funds from:
(i) the Medicaid Expansion Fund;
(ii) county contributions to the nonfederal share of Medicaid expenditures; or
(iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
expenditures; and
(c) closes the Medicaid program to new enrollment under the Medicaid expansion
under this Subsection (3) if the department projects that the cost of the Medicaid expansion
under this Subsection (3) will exceed the appropriations for the fiscal year that are authorized
by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1, Budgetary Procedures Act.
(4) (a) The department shall expand the Medicaid program in accordance with this
Subsection (4) if the department:
(i) receives approval from CMS to:
(A) expand Medicaid coverage to eligible individuals whose income is below 95% of
the federal poverty level;
(B) obtain maximum federal financial participation under 42 U.S.C. Sec. 1396d(y) for
enrolling an individual in the Medicaid expansion under this Subsection (4); and
(C) permit the state to close enrollment in the Medicaid expansion under this
Subsection (4) if the department has insufficient funds to provide services to new enrollment
under the Medicaid expansion under this Subsection (4);
(ii) pays the state portion of costs for the Medicaid expansion under this Subsection (4)
with funds from:
(A) the Medicaid Expansion Fund;
(B) county contributions to the nonfederal share of Medicaid expenditures; or
(C) any other contributions, funds, or transfers from a nonstate agency for Medicaid
expenditures; and
(iii) closes the Medicaid program to new enrollment under the Medicaid expansion
under this Subsection (4) if the department projects that the cost of the Medicaid expansion
under this Subsection (4) will exceed the appropriations for the fiscal year that are authorized
by the Legislature through an appropriations act adopted in accordance with Title 63J, Chapter
1, Budgetary Procedures Act.
(b) The department shall submit a waiver, an amendment to an existing waiver, or a
state plan amendment to CMS to:
(i) administer federal funds for the Medicaid expansion under this Subsection (4)
according to a per capita cap developed by the department that includes an annual inflationary
adjustment, accounts for differences in cost among categories of Medicaid expansion enrollees,
and provides greater flexibility to the state than the current Medicaid payment model;
(ii) limit, in certain circumstances as defined by the department, the ability of a
qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
enrolled in a Medicaid expansion under this Subsection (4);
(iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
this Subsection (4) violates certain program requirements as defined by the department;
(iv) allow an individual enrolled in a Medicaid expansion under this Subsection (4) to
remain in the Medicaid program for up to a 12-month certification period as defined by the
department; and
(v) allow federal Medicaid funds to be used for housing support for eligible enrollees
in the Medicaid expansion under this Subsection (4).
(5) (a) (i) If CMS does not approve a waiver to expand the Medicaid program in
accordance with Subsection (4)(a) on or before January 1, 2020, the department shall develop
proposals to implement additional flexibilities and cost controls, including cost sharing tools,
within a Medicaid expansion under this Subsection (5) through a request to CMS for a waiver
or state plan amendment.
(ii) The request for a waiver or state plan amendment described in Subsection (5)(a)(i)
shall include:
(A) a path to self-sufficiency for qualified adults in the Medicaid expansion that
includes employment and training as defined in 7 U.S.C. Sec. 2015(d)(4); and
(B) a requirement that an individual who is offered a private health benefit plan by an
employer to enroll in the employer's health plan.
(iii) The department shall submit the request for a waiver or state plan amendment
developed under Subsection (5)(a)(i) on or before March 15, 2020.
(b) Notwithstanding Sections 
26-18-18
 and 
63J-5-204
, and in accordance with this
Subsection (5), eligibility for the Medicaid program shall be expanded to include all persons in
the optional Medicaid expansion population under the Patient Protection and Affordable Care
Act, Pub. L. No. 111-148 and the Health Care Education Reconciliation Act of 2010, Pub. L.
No. 111-152, and related federal regulations and guidance, on the earlier of:
(i) the day on which CMS approves a waiver to implement the provisions described in
Subsections (5)(a)(ii)(A) and (B); or
(ii) July 1, 2020.
(c) The department shall seek a waiver, or an amendment to an existing waiver, from
federal law to:
(i) implement each provision described in Subsections 
26-18-415
(2)(b)(iii) through
(viii) in a Medicaid expansion under this Subsection (5);
(ii) limit, in certain circumstances as defined by the department, the ability of a
qualified entity to determine presumptive eligibility for Medicaid coverage for an individual
enrolled in a Medicaid expansion under this Subsection (5); and
(iii) impose a lock-out period if an individual enrolled in a Medicaid expansion under
this Subsection (5) violates certain program requirements as defined by the department.
(d) The eligibility criteria in this Subsection (5) shall be construed to include all
individuals eligible for the health coverage improvement program under Section 
26-18-411
.
(e) The department shall pay the state portion of costs for a Medicaid expansion under
this Subsection (5) entirely from:
(i) the Medicaid Expansion Fund;
(ii) county contributions to the nonfederal share of Medicaid expenditures; or
(iii) any other contributions, funds, or transfers from a nonstate agency for Medicaid
expenditures.
(f) If the costs of the Medicaid expansion under this Subsection (5) exceed the funds
available under Subsection (5)(e):
(i) the department may reduce or eliminate optional Medicaid services under this
chapter; and
(ii) savings, as determined by the department, from the reduction or elimination of
optional Medicaid services under Subsection (5)(f)(i) shall be deposited into the Medicaid
Expansion Fund; and
(iii) the department may submit to CMS a request for waivers, or an amendment of
existing waivers, from federal law necessary to implement budget controls within the Medicaid
program to address the deficiency.
(g) If the costs of the Medicaid expansion under this Subsection (5) are projected by
the department to exceed the funds available in the current fiscal year under Subsection (5)(e),
including savings resulting from any action taken under Subsection (5)(f):
(i) the governor shall direct the Department of Health, Department of Human Services,
and Department of Workforce Services to reduce commitments and expenditures by an amount
sufficient to offset the deficiency:
(A) proportionate to the share of total current fiscal year General Fund appropriations
for each of those agencies; and
(B) up to 10% of each agency's total current fiscal year General Fund appropriations;
[
and
]
(ii) the Division of Finance shall reduce allotments to the Department of Health,
Department of Human Services, and Department of Workforce Services by a percentage:
(A) proportionate to the amount of the deficiency; and
(B) up to 10% of each agency's total current fiscal year General Fund appropriations;
[
and
]
(iii) the Division of Finance shall deposit the total amount from the reduced allotments
described in Subsection (5)(g)(ii) into the Medicaid Expansion Fund.
(6) The department shall maximize federal financial participation in implementing this
section, including by seeking to obtain any necessary federal approvals or waivers.
(7) Notwithstanding Sections 
17-43-201
 and 
17-43-301
, a county does not have to
provide matching funds to the state for the cost of providing Medicaid services to newly
enrolled individuals who qualify for Medicaid coverage under a Medicaid expansion.
(8) The department shall report to the Social Services Appropriations Subcommittee on
or before November 1 of each year that a Medicaid expansion is operational:
(a) the number of individuals who enrolled in the Medicaid expansion;
(b) costs to the state for the Medicaid expansion;
(c) estimated costs to the state for the Medicaid expansion for the current and
following fiscal years; [
and
]
(d) recommendations to control costs of the Medicaid expansion[
.
]
; and
(e) as calculated in accordance with Subsections 
26-36b-204
(4) and 
26-36c-204
(2), the
state's net cost of the qualified Medicaid expansion.
Section 6. Section 
26-18-5
 is amended to read:
26-18-5.
Contracts for provision of medical services -- Federal provisions
modifying department rules -- Compliance with Social Security Act.
(1) The department may contract with other public or private agencies to purchase or
provide medical services in connection with the programs of the division. Where these
programs are used by other [
state agencies
] 
government entities
, contracts shall provide that
other [
state agencies
] 
government entities, in compliance with state and federal law regarding
intergovernmental transfers,
 transfer the state matching funds to the department in amounts
sufficient to satisfy needs of the specified program.
(2) Contract terms shall include provisions for maintenance, administration, and
service costs.
(3) If a federal legislative or executive provision requires modifications or revisions in
an eligibility factor established under this chapter as a condition for participation in medical
assistance, the department may modify or change its rules as necessary to qualify for
participation.
(4) The provisions of this section do not apply to department rules governing abortion.
(5) The department shall comply with all pertinent requirements of the Social Security
Act and all orders, rules, and regulations adopted thereunder when required as a condition of
participation in benefits under the Social Security Act.
Section 7. Section 
26-18-8
 is amended to read:
26-18-8.
Enforcement of public assistance statutes.
(1) The department shall enforce or contract for the enforcement of Sections
35A-1-503
, 
35A-3-108
, 
35A-3-110
, 
35A-3-111
, 
35A-3-112
, and 
35A-3-603
 [
insofar as
] 
to the
extent that
 these sections pertain to benefits conferred or administered by the division under
this chapter
, to the extent allowed under federal law or regulation
.
(2) The department may contract for services covered in Section 
35A-3-111
 insofar as
that section pertains to benefits conferred or administered by the division under this chapter.
Section 8. Section 
26-18-103
 is amended to read:
26-18-103.
DUR Board -- Responsibilities.
The board shall:
(1) develop rules necessary to carry out its responsibilities as defined in this part;
(2) oversee the implementation of a Medicaid retrospective and prospective DUR
program in accordance with this part, including responsibility for approving provisions of
contractual agreements between the Medicaid program and any other entity that will process
and review Medicaid drug claims and profiles for the DUR program in accordance with this
part;
(3) develop and apply predetermined criteria and standards to be used in retrospective
and prospective DUR, ensuring that the criteria and standards are based on the compendia, and
that they are developed with professional input, in a consensus fashion, with provisions for
timely revision and assessment as necessary. The DUR standards developed by the board shall
reflect the local practices of physicians in order to monitor:
(a) therapeutic appropriateness;
(b) overutilization or underutilization;
(c) therapeutic duplication;
(d) drug-disease contraindications;
(e) drug-drug interactions;
(f) incorrect drug dosage or duration of drug treatment; and
(g) clinical abuse and misuse;
(4) develop, select, apply, and assess interventions and remedial strategies for
physicians, pharmacists, and recipients that are educational and not punitive in nature, in order
to improve the quality of care;
(5) disseminate information to physicians and pharmacists to ensure that they are aware
of the board's duties and powers;
(6) provide written, oral, or electronic reminders of patient-specific or drug-specific
information, designed to ensure recipient, physician, and pharmacist confidentiality, and
suggest changes in prescribing or dispensing practices designed to improve the quality of care;
(7) utilize face-to-face discussions between experts in drug therapy and the prescriber
or pharmacist who has been targeted for educational intervention;
(8) conduct intensified reviews or monitoring of selected prescribers or pharmacists;
(9) create an educational program using data provided through DUR to provide active
and ongoing educational outreach programs to improve prescribing and dispensing practices,
either directly or by contract with other governmental or private entities;
(10) provide a timely evaluation of intervention to determine if those interventions
have improved the quality of care;
[
(11) publish an annual report, subject to public comment prior to its issuance, and
submit that report to the United States Department of Health and Human Services by
December 1 of each year. That report shall also be submitted to the executive director, the
president of the Utah Pharmaceutical Association, and the president of the Utah Medical
Association by December 1 of each year. The report shall include:
]
[
(a) an overview of the activities of the board and the DUR program;
]
[
(b) a description of interventions used and their effectiveness, specifying whether the
intervention was a result of underutilization or overutilization of drugs, without disclosing the
identities of individual physicians, pharmacists, or recipients;
]
[
(c) the costs of administering the DUR program;
]
[
(d) any fiscal savings resulting from the DUR program;
]
[
(e) an overview of the fiscal impact of the DUR program to other areas of the
Medicaid program such as hospitalization or long-term care costs;
]
[
(f) a quantifiable assessment of whether DUR has improved the recipient's quality of
care;
]
[
(g) a review of the total number of prescriptions, by drug therapeutic class;
]
[
(h) an assessment of the impact of educational programs or interventions on
prescribing or dispensing practices; and
]
[
(i) recommendations for DUR program improvement;
]
(11) publish the annual Drug Utilization Review report required under 42 C.F.R. Sec.
712;
(12) develop a working agreement with related boards or agencies, including the State
Board of Pharmacy, Physicians' Licensing Board, and SURS staff within the division, in order
to clarify areas of responsibility for each, where those areas may overlap;
(13) establish a grievance process for physicians and pharmacists under this part, in
accordance with Title 63G, Chapter 4, Administrative Procedures Act;
(14) publish and disseminate educational information to physicians and pharmacists
concerning the board and the DUR program, including information regarding:
(a) identification and reduction of the frequency of patterns of fraud, abuse, gross
overuse, inappropriate, or medically unnecessary care among physicians, pharmacists, and
recipients;
(b) potential or actual severe or adverse reactions to drugs;
(c) therapeutic appropriateness;
(d) overutilization or underutilization;
(e) appropriate use of generics;
(f) therapeutic duplication;
(g) drug-disease contraindications;
(h) drug-drug interactions;
(i) incorrect drug dosage and duration of drug treatment;
(j) drug allergy interactions; and
(k) clinical abuse and misuse;
(15) develop and publish, with the input of the State Board of Pharmacy, guidelines
and standards to be used by pharmacists in counseling Medicaid recipients in accordance with
this part. The guidelines shall ensure that the recipient may refuse counseling and that the
refusal is to be documented by the pharmacist. Items to be discussed as part of that counseling
include:
(a) the name and description of the medication;
(b) administration, form, and duration of therapy;
(c) special directions and precautions for use;
(d) common severe side effects or interactions, and therapeutic interactions, and how to
avoid those occurrences;
(e) techniques for self-monitoring drug therapy;
(f) proper storage;
(g) prescription refill information; and
(h) action to be taken in the event of a missed dose; and
(16) establish procedures in cooperation with the State Board of Pharmacy for
pharmacists to record information to be collected under this part. The recorded information
shall include:
(a) the name, address, age, and gender of the recipient;
(b) individual history of the recipient where significant, including disease state, known
allergies and drug reactions, and a comprehensive list of medications and relevant devices;
(c) the pharmacist's comments on the individual's drug therapy;
(d) name of prescriber; and
(e) name of drug, dose, duration of therapy, and directions for use.
Section 9. Section 
26-18-408
 is amended to read:
26-18-408.
Incentives to appropriately use emergency department services.
(1) (a) This section applies to the Medicaid program and to the Utah Children's Health
Insurance Program created in Chapter 40, Utah Children's Health Insurance Act.
(b) [
For purposes of
] 
As used in
 this section:
(i) [
"Accountable
] 
"Managed
 care organization" means a [
Medicaid or Children's
Health Insurance Program administrator
] 
comprehensive full risk managed care delivery
system
 that contracts with the Medicaid program or the Children's Health Insurance Program to
deliver health care through [
an accountable
] 
a managed
 care plan.
(ii) [
"Accountable
] 
"Managed
 care plan" means a [
risk based
] 
risk-based
 delivery
service model authorized by Section 
26-18-405
 and administered by [
an accountable
] 
a
managed
 care organization.
(iii) [
"Nonemergent
] 
"Non-emergent
 care":
(A) means use of the emergency department to receive health care that is
[
nonemergent
] 
non-emergent
 as defined by the department by administrative rule adopted in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and the
Emergency Medical Treatment and Active Labor Act; and
(B) does not mean the medical services provided to [
a recipient
] 
an individual
 required
by the Emergency Medical Treatment and Active Labor Act, including services to conduct a
medical screening examination to determine if the recipient has an emergent or [
nonemergent
]
non-emergent
 condition.
(iv) "Professional compensation" means payment made for services rendered to a
Medicaid recipient by an individual licensed to provide health care services.
(v) "Super-utilizer" means a Medicaid recipient who has been identified by the
recipient's [
accountable
] 
managed
 care organization as a person who uses the emergency
department excessively, as defined by the [
accountable
] 
managed
 care organization.
(2) (a) [
An accountable
] 
A managed
 care organization may, in accordance with
Subsections (2)(b) and (c):
(i) audit emergency department services provided to a recipient enrolled in the
[
accountable
] 
managed
 care plan to determine if [
nonemergent
] 
non-emergent
 care was
provided to the recipient; and
(ii) establish differential payment for emergent and [
nonemergent
] 
non-emergent
 care
provided in an emergency department.
(b) (i) The differential payments under Subsection (2)(a)(ii) do not apply to
professional compensation for services rendered in an emergency department.
(ii) Except in cases of suspected fraud, waste, and abuse, [
an accountable
] 
managed
care organization's audit of payment under Subsection (2)(a)(i) is limited to the 18-month
period of time after the date on which the medical services were provided to the recipient. If
fraud, waste, or abuse is alleged, the [
accountable
] 
managed
 care organization's audit of
payment under Subsection (2)(a)(i) is limited to three years after the date on which the medical
services were provided to the recipient.
(c) The audits and differential payments under Subsections (2)(a) and (b) apply to
services provided to a recipient on or after July 1, 2015.
(3) [
An accountable
] 
A managed
 care organization shall:
(a) use the savings under Subsection (2) to maintain and improve access to primary
care and urgent care services for all [
of the
] 
Medicaid or CHIP
 recipients enrolled in the
[
accountable
] 
managed
 care plan;
(b) provide viable alternatives for increasing primary care provider reimbursement
rates to incentivize after hours primary care access for recipients; and
(c) report to the department on how the [
accountable
] 
managed
 care organization
complied with this Subsection (3).
(4) The department [
shall
] 
may
:
(a) through administrative rule adopted by the department, develop quality
measurements that evaluate [
an accountable
] 
a managed
 care organization's delivery of:
(i) appropriate emergency department services to recipients enrolled in the
[
accountable
] 
managed
 care plan;
(ii) expanded primary care and urgent care for recipients enrolled in the [
accountable
]
managed
 care plan, with consideration of the [
accountable
] 
managed
 care organization's:
(A) delivery of primary care, urgent care, and after hours care through means other than
the emergency department;
(B) recipient access to primary care providers and community health centers including
evening and weekend access; and
(C) other innovations for expanding access to primary care; and
(iii) quality of care for the [
accountable
] 
managed
 care plan members;
(b) compare the quality measures developed under Subsection (4)(a) for each
[
accountable care organization and share the data and quality measures developed under
Subsection (4)(a) with the Health Data Committee created in Chapter 33a, Utah Health Data
Authority Act;
] 
managed care organization; and
[
(c) apply for a Medicaid waiver and a Children's Health Insurance Program waiver
with CMS, to:
]
[
(i) allow the program to charge recipients who are enrolled in an accountable care plan
a higher copayment for emergency department services; and
]
[
(ii)
] 
(c)
 develop, by administrative rule, an algorithm to determine assignment of new,
unassigned recipients to specific [
accountable
] 
managed
 care plans based on the plan's
performance in relation to the quality measures developed pursuant to Subsection (4)(a)[
; and
]
.
[
(d) before July 1, 2015, convene representatives from the accountable care
organizations, pre-paid mental health plans, an organization representing hospitals, an
organization representing physicians, and a county mental health and substance abuse authority
to discuss alternatives to emergency department care, including:
]
[
(i) creating increased access to primary care services;
]
[
(ii) alternative care settings for super-utilizers and individuals with behavioral health
or substance abuse issues;
]
[
(iii) primary care medical and health homes that can be created and supported through
enhanced federal match rates, a state plan amendment for integrated care models, or other
Medicaid waivers;
]
[
(iv) case management programs that can:
]
[
(A) schedule prompt visits with primary care providers within 72 to 96 hours of an
emergency department visit;
]
[
(B) help super-utilizers with behavioral health or substance abuse issues to obtain care
in appropriate care settings; and
]
[
(C) assist with transportation to primary care visits if transportation is a barrier to
appropriate care for the recipient; and
]
[
(v) sharing of medical records between health care providers and emergency
departments for Medicaid recipients.
]
[
(5) The Health Data Committee may publish data in accordance with Chapter 33a,
Utah Health Data Authority Act, which compares the quality measures for the accountable care
plans.
]
Section 10. Section 
26-18-411
 is amended to read:
26-18-411.
Health coverage improvement program -- Eligibility -- Annual report
-- Expansion of eligibility for adults with dependent children.
(1) For purposes of this section:
(a) "Adult in the expansion population" means an individual who:
(i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
(ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
individual.
(b) "Enhancement waiver program" means the Primary Care Network enhancement
waiver program described in Section 
26-18-416
.
(c) "Federal poverty level" means the poverty guidelines established by the Secretary of
the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2).
(d) "Health coverage improvement program" means the health coverage improvement
program described in Subsections (3) through (10).
(e) "Homeless":
(i) means an individual who is chronically homeless, as determined by the department;
and
(ii) includes someone who was chronically homeless and is currently living in
supported housing for the chronically homeless.
(f) "Income eligibility ceiling" means the percent of federal poverty level:
(i) established by the state in an appropriations act adopted pursuant to Title 63J,
Chapter 1, Budgetary Procedures Act; and
(ii) under which an individual may qualify for Medicaid coverage in accordance with
this section.
(2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
allow temporary residential treatment for substance abuse, for the traditional Medicaid
population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan, as approved by CMS and as long as the county makes the
required match under Section 
17-43-201
.
(3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
increase the income eligibility ceiling to a percentage of the federal poverty level designated by
the department, based on appropriations for the program, for an individual with a dependent
child.
(4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
amendment of existing waivers, from federal statutory and regulatory law necessary for the
state to implement the health coverage improvement program in the Medicaid program in
accordance with this section.
(5) (a) An adult in the expansion population is eligible for Medicaid if the adult meets
the income eligibility and other criteria established under Subsection (6).
(b) An adult who qualifies under Subsection (6) shall receive Medicaid coverage:
(i) through the traditional fee for service Medicaid model in counties without Medicaid
accountable care organizations or the state's Medicaid accountable care organization delivery
system, where implemented;
(ii) except as provided in Subsection (5)(b)(iii), for behavioral health, through the
counties in accordance with Sections 
17-43-201
 and 
17-43-301
;
(iii) that integrates behavioral health services and physical health services with
Medicaid accountable care organizations in select geographic areas of the state that choose an
integrated model; and
(iv) that permits temporary residential treatment for substance abuse in a short term,
non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan.
(c) Medicaid accountable care organizations and counties that elect to integrate care
under Subsection (5)(b)(iii) shall collaborate on enrollment, engagement of patients, and
coordination of services.
(6) (a) An individual is eligible for the health coverage improvement program under
Subsection (5) if:
(i) at the time of enrollment, the individual's annual income is below the income
eligibility ceiling established by the state under Subsection (1)(f); and
(ii) the individual meets the eligibility criteria established by the department under
Subsection (6)(b).
(b) Based on available funding and approval from CMS, the department shall select the
criteria for an individual to qualify for the Medicaid program under Subsection (6)(a)(ii), based
on the following priority:
(i) a chronically homeless individual;
(ii) if funding is available, an individual:
(A) involved in the justice system through probation, parole, or court ordered
treatment; and
(B) in need of substance abuse treatment or mental health treatment, as determined by
the department; or
(iii) if funding is available, an individual in need of substance abuse treatment or
mental health treatment, as determined by the department.
(c) An individual who qualifies for Medicaid coverage under Subsections (6)(a) and (b)
may remain on the Medicaid program for a 12-month certification period as defined by the
department. Eligibility changes made by the department under Subsection (1)(f) or (6)(b) shall
not apply to an individual during the 12-month certification period.
(7) The state may request a modification of the income eligibility ceiling and other
eligibility criteria under Subsection (6) each fiscal year based on [
enrollment in the health
coverage improvement program,
] projected enrollment, costs to the state, and the state budget.
(8) Before September 30 of each year, the department shall report to the Health and
Human Services Interim Committee and to the Executive Appropriations Committee:
(a) the number of individuals who enrolled in Medicaid under Subsection (6);
(b) the state cost of providing Medicaid to individuals enrolled under Subsection (6);
and
(c) recommendations for adjusting the income eligibility ceiling under Subsection (7),
and other eligibility criteria under Subsection (6), for the upcoming fiscal year.
(9) The current Medicaid program and the health coverage improvement program,
when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
enrollment for an individual who is released from custody and was eligible for or enrolled in
Medicaid before incarceration.
(10) Notwithstanding Sections 
17-43-201
 and 
17-43-301
, a county does not have to
provide matching funds to the state for the cost of providing Medicaid services to newly
enrolled individuals who qualify for Medicaid coverage under the health coverage
improvement program under Subsection (6).
(11) If the enhancement waiver program is implemented, the department:
(a) may not accept any new enrollees into the health coverage improvement program
after the day on which the enhancement waiver program is implemented;
(b) shall transition all individuals who are enrolled in the health coverage improvement
program into the enhancement waiver program;
(c) shall suspend the health coverage improvement program within one year after the
day on which the enhancement waiver program is implemented;
(d) shall, within one year after the day on which the enhancement waiver program is
implemented, use all appropriations for the health coverage improvement program to
implement the enhancement waiver program; and
(e) shall work with CMS to maintain any waiver for the health coverage improvement
program while the health coverage improvement program is suspended under Subsection
(11)(c).
(12) If, after the enhancement waiver program takes effect, the enhancement waiver
program is repealed or suspended by either the state or federal government, the department
shall reinstate the health coverage improvement program and continue to accept new enrollees
into the health coverage improvement program in accordance with the provisions of this
section.
Section 11. Section 
26-18-413
 is amended to read:
26-18-413.
 Medicaid waiver for delivery of adult dental services.
(1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from
federal statutory and regulatory law necessary for the Medicaid program to provide dental
services in the manner described in Subsection (2)(a).
(b) Before June 30, 2018, the department shall submit to CMS a request for waivers, or
an amendment of existing waivers, from federal law necessary for the state to provide dental
services, in accordance with Subsections (2)(b)(i) and (d) through (g), to an individual
described in Subsection (2)(b)(i).
(c) Before June 30, 2019, the department shall submit to the Centers for Medicare and
Medicaid Services a request for waivers, or an amendment to existing waivers, from federal
law necessary for the state to:
(i) provide dental services, in accordance with Subsections (2)(b)(ii) and (d) through
(g) to an individual described in Subsection (2)(b)(ii); and
(ii) provide the services described in Subsection (2)(h).
(2) (a) To the extent funded, the department shall provide services to only blind or
disabled individuals, as defined in 42 U.S.C. Sec. 1382c(a)(1), who are 18 years old or older
and eligible for the program.
(b) Notwithstanding Subsection (2)(a):
(i) if a waiver is approved under Subsection (1)(b), the department shall provide dental
services to an individual who:
(A) qualifies for the health coverage improvement program described in Section
26-18-411
; and
(B) is receiving treatment in a substance abuse treatment program, as defined in
Section 
62A-2-101
, licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities;
and
(ii) if a waiver is approved under Subsection (1)(c)(i), the department shall provide
dental services to an individual who is an aged individual as defined in 42 U.S.C. Sec.
1382c(a)(1).
(c) To the extent possible, services to individuals described in Subsection (2)(a) shall
be provided through the University of Utah School of Dentistry and the University of Utah
School of Dentistry's associated statewide network.
(d) The department shall provide the services to individuals described in Subsection
(2)(b):
(i) by contracting with an entity that:
(A) has demonstrated experience working with individuals who are being treated for
both a substance use disorder and a major oral health disease;
(B) operates a program, targeted at the individuals described in Subsection (2)(b), that
has demonstrated, through a peer-reviewed evaluation, the effectiveness of providing dental
treatment to those individuals described in Subsection (2)(b);
(C) is willing to pay for an amount equal to the program's non-federal share of the cost
of providing dental services to the population described in Subsection (2)(b); and
(D) is willing to pay all state costs associated with applying for the waiver described in
Subsection (1)(b) and administering the program described in Subsection (2)(b); and
(ii) through a fee-for-service payment model.
(e) The entity that receives the contract under Subsection (2)(d)(i) shall cover all state
costs of the program described in Subsection (2)(b).
(f) Each fiscal year, the University of Utah School of Dentistry shall [
transfer money
]
,
in compliance with state and federal regulations regarding intergovernmental transfers, transfer
funds
 to the program in an amount equal to the program's non-federal share of the cost of
providing services under this section through the school during the fiscal year.
[
(g) During each general session of the Legislature, the department shall report to the
Social Services Appropriations Subcommittee whether the University of Utah School of
Dentistry will have sufficient funds to make the transfer required by Subsection (2)(f) for the
current fiscal year.
]
[
(h)
] 
(g)
 If a waiver is approved under Subsection (1)(c)(ii), the department shall
provide coverage for porcelain and porcelain-to-metal crowns if the services are provided:
(i) to an individual who qualifies for dental services under Subsection (2)(b); and
(ii) by an entity that covers all state costs of:
(A) providing the coverage described in this Subsection (2)(h); and
(B) applying for the waiver described in Subsection (1)(c)[
(ii)
].
[
(i)
] 
(h)
 Where possible, the department shall ensure that services described in
Subsection (2)(a) that are not provided by the University of Utah School of Dentistry or the
University of Utah School of Dentistry's associated network are provided:
(i) through fee for service reimbursement until July 1, 2018; and
(ii) after July 1, 2018, through the method of reimbursement used by the division for
Medicaid dental benefits.
[
(j)
] 
(i)
 Subject to appropriations by the Legislature, and as determined by the
department, the scope, amount, duration, and frequency of services may be limited.
[
(3) The reporting requirements of Section 
26-18-3
 apply to the waivers requested
under Subsection (1).
]
[
(4)
] 
(3)
 (a) If the waivers requested under Subsection (1)(a) are granted, the Medicaid
program shall begin providing dental services in the manner described in Subsection (2) no
later than July 1, 2017.
(b) If the waivers requested under Subsection (1)(b) are granted, the Medicaid program
shall begin providing dental services to the population described in Subsection (2)(b) within 90
days from the day on which the waivers are granted.
(c) If the waivers requested under Subsection (1)(c)(i) are granted, the Medicaid
program shall begin providing dental services to the population described in Subsection
(2)(b)(ii) within 90 days after the day on which the waivers are granted.
[
(5)
] 
(4)
 If the federal share of the cost of providing dental services under this section
will be less than 65% during any portion of the next fiscal year, the Medicaid program shall
cease providing dental services under this section no later than the end of the current fiscal
year.
Section 12. Section 
26-36b-204
 is amended to read:
26-36b-204.
Hospital financing of health coverage improvement program
Medicaid waiver expansion -- Hospital share.
(1) The hospital share is:
(a) 45% of the state's net cost of the health coverage improvement program, including
Medicaid coverage for individuals with dependent children up to the federal poverty level
designated under Section 
26-18-411
;
(b) 45% of the state's net cost of the enhancement waiver program;
(c) if the waiver for the Medicaid waiver expansion is approved, $11,900,000; and
(d) 45% of the state's net cost of the upper payment limit gap.
(2) (a) The hospital share is capped at no more than $13,600,000 annually, consisting
of:
(i) an $11,900,000 cap for the programs specified in Subsections (1)(a) through (c);
and
(ii) a $1,700,000 cap for the program specified in Subsection (1)(d).
(b) The department shall prorate the cap described in Subsection (2)(a) in any year in
which the programs specified in Subsections (1)(a) and (d) are not in effect for the full fiscal
year.
(3) Private hospitals shall be assessed under this chapter for:
(a) 69% of the portion of the hospital share for the programs specified in Subsections
(1)(a) through (c); and
(b) 100% of the portion of the hospital share specified in Subsection (1)(d).
(4) (a) [
The department shall, on or before October 15, 2017, and on or before October
of each subsequent year, produce a report that calculates
] 
In the report described in
Subsection 
26-18-3.9
(8), the department shall calculate
 the state's net cost of each of the
programs described in Subsections (1)(a) through (c) that are in effect for that year.
(b) If the assessment collected in the previous fiscal year is above or below the hospital
share for private hospitals for the previous fiscal year, the underpayment or overpayment of the
assessment by the private hospitals shall be applied to the fiscal year in which the report is
issued.
(5) A Medicaid accountable care organization shall, on or before October 15 of each
year, report to the department the following data from the prior state fiscal year for each private
hospital, state teaching hospital, and non-state government hospital provider that the Medicaid
accountable care organization contracts with:
(a) for the traditional Medicaid population:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments; and
(b) if the Medicaid accountable care organization enrolls any individuals in the health
coverage improvement program, the enhancement waiver program, or the Medicaid waiver
expansion, for the population newly eligible for any of those programs:
(i) hospital inpatient payments;
(ii) hospital inpatient discharges;
(iii) hospital inpatient days; and
(iv) hospital outpatient payments.
(6) The department shall, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, provide details surrounding specific content and format for
the reporting by the Medicaid accountable care organization.
Section 13. Section 
26-36b-205
 is amended to read:
26-36b-205.
Calculation of assessment.
(1) (a) Except as provided in Subsection (1)(b), an annual assessment is payable on a
quarterly basis for each private hospital in an amount calculated by the division at a uniform
assessment rate for each hospital discharge, in accordance with this section.
(b) A private teaching hospital with more than 425 beds and 60 residents shall pay an
assessment rate 2.5 times the uniform rate established under Subsection (1)(c).
(c) The division shall calculate the uniform assessment rate described in Subsection
(1)(a) by dividing the hospital share for assessed private hospitals, described in [
Subsection
26-36b-204
(1)
] 
Subsections 
26-36b-204
(1) and 
26-36b-204
(3)
, by the sum of:
(i) the total number of discharges for assessed private hospitals that are not a private
teaching hospital; and
(ii) 2.5 times the number of discharges for a private teaching hospital, described in
Subsection (1)(b).
(d) The division may, by rule made in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, adjust the formula described in Subsection (1)(c) to address
unforeseen circumstances in the administration of the assessment under this chapter.
(e) Any quarterly changes to the uniform assessment rate shall be applied uniformly to
all assessed private hospitals.
(2) Except as provided in Subsection (3), for each state fiscal year, the division shall
determine a hospital's discharges as follows:
(a) for state fiscal year 2017, the hospital's cost report data for the hospital's fiscal year
ending between July 1, 2013, and June 30, 2014; and
(b) for each subsequent state fiscal year, the hospital's cost report data for the hospital's
fiscal year that ended in the state fiscal year two years before the assessment fiscal year.
(3) (a) If a hospital's fiscal year Medicare cost report is not contained in the CMS
Healthcare Cost Report Information System file:
(i) the hospital shall submit to the division a copy of the hospital's Medicare cost report
applicable to the assessment year; and
(ii) the division shall determine the hospital's discharges.
(b) If a hospital is not certified by the Medicare program and is not required to file a
Medicare cost report:
(i) the hospital shall submit to the division the hospital's applicable fiscal year
discharges with supporting documentation;
(ii) the division shall determine the hospital's discharges from the information
submitted under Subsection (3)(b)(i); and
(iii) failure to submit discharge information shall result in an audit of the hospital's
records and a penalty equal to 5% of the calculated assessment.
(4) Except as provided in Subsection (5), if a hospital is owned by an organization that
owns more than one hospital in the state:
(a) the assessment for each hospital shall be separately calculated by the department;
and
(b) each separate hospital shall pay the assessment imposed by this chapter.
(5) If multiple hospitals use the same Medicaid provider number:
(a) the department shall calculate the assessment in the aggregate for the hospitals
using the same Medicaid provider number; and
(b) the hospitals may pay the assessment in the aggregate.
Section 14. Section 
26-36c-204
 is amended to read:
26-36c-204.
Hospital financing.
(1) Private hospitals shall be assessed under this chapter for the portion of the hospital
share described in Section 
26-36c-209
.
(2) [
The department shall, on or before October 15, 2020, and on or before October 15
of each subsequent year, produce a report that calculates
] 
In the report described in Subsection
26-18-3.9
(8), the department shall calculate
 the state's net cost of the qualified Medicaid
expansion.
(3) If the assessment collected in the previous fiscal year is above or below the hospital
share for private hospitals for the previous fiscal year, the division shall apply the
underpayment or overpayment of the assessment by the private hospitals to the fiscal year in
which the report is issued.
Section 15. Section 
26-40-106
 is amended to read:
26-40-106.
Program benefits.
(1) Except as provided in Subsection (3), medical and dental program benefits shall be
benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
(a) medical program benefits, including behavioral health care benefits, shall be
benchmarked [
on
] 
effective
 July 1, 2019, and on July 1 every third year thereafter, to:
(i) be substantially equal to a health benefit plan with the largest insured commercial
enrollment offered by a health maintenance organization in the state; and
(ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No.
110-343; and
(b) dental program benefits shall be benchmarked [
on
] 
effective
 July 1, 2019, and on
July 1 every third year thereafter in accordance with the Children's Health Insurance Program
Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the
largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the
state, except that the utilization review mechanism for orthodontia shall be based on medical
necessity.
(2) On or before [
January 31
] 
July 1
 of each year, the department shall publish the
benchmark for dental program benefits established under Subsection (1)(b).
(3) The program benefits for enrollees who are at or below 100% of the federal poverty
level are exempt from the benchmark requirements of Subsections (1) and (2).
Section 16. Section 
62A-2-120
 is amended to read:
62A-2-120.
Background check -- Direct access to children or vulnerable adults.
(1) As used in this section:
(a) (i) "Applicant" means:
(A) the same as that term is defined in Section 
62A-2-101
;
(B) an individual who is associated with a licensee and has or will likely have direct
access to a child or a vulnerable adult;
(C) an individual who provides respite care to a foster parent or an adoptive parent on
more than one occasion;
(D) a department contractor;
(E) a guardian submitting an application on behalf of an individual, other than the child
or vulnerable adult who is receiving the service, if the individual is 12 years of age or older and
resides in a home, that is licensed or certified by the office, with the child or vulnerable adult
who is receiving services; or
(F) a guardian submitting an application on behalf of an individual, other than the child
or vulnerable adult who is receiving the service, if the individual is 12 years of age or older and
is a person described in Subsection (1)(a)(i)(A), (B), (C), or (D).
(ii) "Applicant" does not mean an individual, including an adult, who is in the custody
of the Division of Child and Family Services or the Division of Juvenile Justice Services.
(b) "Application" means a background screening application to the office.
(c) "Bureau" means the Bureau of Criminal Identification within the Department of
Public Safety, created in Section 
53-10-201
.
(d) "Incidental care" means occasional care, not in excess of five hours per week and
never overnight, for a foster child. 
(e) "Personal identifying information" means:
(i) current name, former names, nicknames, and aliases;
(ii) date of birth;
(iii) physical address and email address;
(iv) telephone number;
(v) driver license or other government-issued identification;
(vi) social security number;
(vii) only for applicants who are 18 years of age or older, fingerprints, in a form
specified by the office; and
(viii) other information specified by the office by rule made in accordance with Title
63G, Chapter 3, Utah Administrative Rulemaking Act.
(2) (a) Except as provided in Subsection (13), an applicant 
or a representative
 shall
submit the following to the office:
(i) personal identifying information;
(ii) a fee established by the office under Section 
63J-1-504
; and
(iii) a 
disclosure
 form, specified by the office, for consent for:
(A) an initial background check upon submission of the information described under
this Subsection (2)(a);
[
(B) a background check at the applicant's annual renewal;
]
(B) ongoing monitoring of fingerprints and registries until no longer associated with a
licensee for 90 days;
(C) a background check when the office determines that reasonable cause exists; and
(D) retention of personal identifying information, including fingerprints, for
monitoring and notification as described in Subsections (3)(d) and (4).
(b) In addition to the requirements described in Subsection (2)(a), if an applicant [
spent
time
] 
resided
 outside of the United States and its territories during the five years immediately
preceding the day on which the information described in Subsection (2)(a) is submitted to the
office, the office may require the applicant to submit documentation establishing whether the
applicant was convicted of a crime during the time that the applicant [
spent
] 
resided
 outside of
the United States or its territories.
(3) The office:
(a) shall perform the following duties as part of a background check of an applicant:
(i) check state and regional criminal background databases for the applicant's criminal
history by:
(A) submitting personal identifying information to the bureau for a search; or
(B) using the applicant's personal identifying information to search state and regional
criminal background databases as authorized under Section 
53-10-108
;
(ii) submit the applicant's personal identifying information and fingerprints to the
bureau for a criminal history search of applicable national criminal background databases;
(iii) search the Department of Human Services, Division of Child and Family Services'
Licensing Information System described in Section 
62A-4a-1006
;
(iv) search the Department of Human Services, Division of Aging and Adult Services'
vulnerable adult abuse, neglect, or exploitation database described in Section 
62A-3-311.1
;
(v) search the juvenile court records for substantiated findings of severe child abuse or
neglect described in Section 
78A-6-323
; and
(vi) search the juvenile court arrest, adjudication, and disposition records, as provided
under Section 
78A-6-209
;
(b) shall conduct a background check of an applicant for an initial background check
upon submission of the information described under Subsection (2)(a);
(c) may conduct all or portions of a background check of an applicant, as provided by
rule, made by the office in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act:
(i) for an annual renewal; or
(ii) when the office determines that reasonable cause exists;
(d) may submit an applicant's personal identifying information, including fingerprints,
to the bureau for checking, retaining, and monitoring of state and national criminal background
databases and for notifying the office of new criminal activity associated with the applicant;
(e) shall track the status of an approved applicant under this section to ensure that an
approved applicant is not required to duplicate the submission of the applicant's fingerprints if
the applicant applies for:
(i) more than one license;
(ii) direct access to a child or a vulnerable adult in more than one human services
program; or
(iii) direct access to a child or a vulnerable adult under a contract with the department;
(f) shall track the status of each license and each individual with direct access to a child
or a vulnerable adult and notify the bureau [
when the license has expired
] 
within 90 days after
the day on which the license expires
 or the individual's direct access to a child or a vulnerable
adult [
has ceased
] 
ceases
;
(g) shall adopt measures to strictly limit access to personal identifying information
solely to the [
office employees
] 
individuals
 responsible for processing 
and entering
 the
applications for background checks and to protect the security of the personal identifying
information the office reviews under this Subsection (3);
(h) as necessary to comply with the federal requirement to check a state's child abuse
and neglect registry regarding any individual working in a program under this section that
serves children, shall:
(i) search the Department of Human Services, Division of Child and Family Services'
Licensing Information System described in Section 
62A-4a-1006
; and
(ii) require the child abuse and neglect registry be checked in each state where an
applicant resided at any time during the five years immediately preceding the day on which the
applicant submits the information described in Subsection (2)(a) to the office; and
(i) shall make rules, in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act, to implement the provisions of this Subsection (3) relating to background
checks.
(4) (a) With the personal identifying information the office submits to the bureau under
Subsection (3), the bureau shall check against state and regional criminal background databases
for the applicant's criminal history.
(b) With the personal identifying information and fingerprints the office submits to the
bureau under Subsection (3), the bureau shall check against national criminal background
databases for the applicant's criminal history.
(c) Upon direction from the office, and with the personal identifying information and
fingerprints the office submits to the bureau under Subsection (3)(d), the bureau shall:
(i) maintain a separate file of the fingerprints for search by future submissions to the
local and regional criminal records databases, including latent prints; and
(ii) monitor state and regional criminal background databases and identify criminal
activity associated with the applicant.
(d) The bureau is authorized to submit the fingerprints to the Federal Bureau of
Investigation Next Generation Identification System, to be retained in the Federal Bureau of
Investigation Next Generation Identification System for the purpose of:
(i) being searched by future submissions to the national criminal records databases,
including the Federal Bureau of Investigation Next Generation Identification System and latent
prints; and
(ii) monitoring national criminal background databases and identifying criminal
activity associated with the applicant.
(e) The Bureau shall notify and release to the office all information of criminal activity
associated with the applicant.
(f) Upon notice from the office that a license has expired or an individual's direct
access to a child or a vulnerable adult has ceased 
for 90 days
, the bureau shall:
(i) discard and destroy any retained fingerprints; and
(ii) notify the Federal Bureau of Investigation when the license has expired or an
individual's direct access to a child or a vulnerable adult has ceased, so that the Federal Bureau
of Investigation will discard and destroy the retained fingerprints from the Federal Bureau of
Investigation Next Generation Identification System.
(5) (a) After conducting the background check described in Subsections (3) and (4), the
office shall deny an application to an applicant who, within three years before the day on which
the applicant submits information to the office under Subsection (2) for a background check,
has been convicted of any of the following, regardless of whether the offense is a felony, a
misdemeanor, or an infraction:
(i) an offense identified as domestic violence, lewdness, voyeurism, battery, cruelty to
animals, or bestiality;
(ii) a violation of any pornography law, including sexual exploitation of a minor;
(iii) prostitution;
(iv) an offense included in:
(A) Title 76, Chapter 5, Offenses Against the Person;
(B) Section 
76-5b-201
, Sexual Exploitation of a Minor; or
(C) Title 76, Chapter 7, Offenses Against the Family;
(v) aggravated arson, as described in Section 
76-6-103
;
(vi) aggravated burglary, as described in Section 
76-6-203
;
(vii) aggravated robbery, as described in Section 
76-6-302
;
(viii) identity fraud crime, as described in Section 
76-6-1102
; or
(ix) [
a conviction for
] a felony or misdemeanor offense committed outside of the state
that, if committed in the state, would constitute a violation of an offense described in
Subsections (5)(a)(i) through (viii).
(b) If the office denies an application to an applicant based on a conviction described in
Subsection (5)(a), the applicant is not entitled to a comprehensive review described in
Subsection (6).
(c) If the applicant will be working in a program serving only adults whose only
impairment is a mental health diagnosis, including that of a serious mental health disorder,
with or without co-occurring substance use disorder, the denial provisions of Subsection (5)(a)
do not apply, and the office shall conduct a comprehensive review as described in Subsection
(6).
(6) (a) The office shall conduct a comprehensive review of an applicant's background
check if the applicant:
(i) has 
an open court case or
 a conviction for any felony offense, not described in
Subsection (5)(a), [
regardless of the date of the conviction
] 
with a date of conviction that is no
more than 10 years before the date on which the applicant submits the application
;
(ii) has 
an open court case or
 a conviction for a misdemeanor offense, not described in
Subsection (5)(a), and designated by the office, by rule, in accordance with Title 63G, Chapter
3, Utah Administrative Rulemaking Act, if the conviction is within [
five
] 
three
 years before the
day on which the applicant submits information to the office under Subsection (2) for a
background check;
(iii) has a conviction for any offense described in Subsection (5)(a) that occurred more
than three years before the day on which the applicant submitted information under Subsection
(2)(a);
(iv) is currently subject to a plea in abeyance or diversion agreement for any offense
described in Subsection (5)(a);
(v) has a listing in the Department of Human Services, Division of Child and Family
Services' Licensing Information System described in Section 
62A-4a-1006
;
(vi) has a listing in the Department of Human Services, Division of Aging and Adult
Services' vulnerable adult abuse, neglect, or exploitation database described in Section
62A-3-311.1
;
(vii) has a record in the juvenile court of a substantiated finding of severe child abuse
or neglect described in Section 
78A-6-323
;
(viii) has a record of an adjudication in juvenile court for an act that, if committed by
an adult, would be a felony or misdemeanor, if the applicant is:
(A) under 28 years of age; or
(B) 28 years of age or older and has been convicted of, has pleaded no contest to, or is
currently subject to a plea in abeyance or diversion agreement for a felony or a misdemeanor
offense described in Subsection (5)(a); [
or
]
(ix) has a pending charge for an offense described in Subsection (5)(a)[
.
]
; or
(x) is an applicant described in Subsection (5)(c).
(b) The comprehensive review described in Subsection (6)(a) shall include an
examination of:
(i) the date of the offense or incident;
(ii) the nature and seriousness of the offense or incident;
(iii) the circumstances under which the offense or incident occurred;
(iv) the age of the perpetrator when the offense or incident occurred;
(v) whether the offense or incident was an isolated or repeated incident;
(vi) whether the offense or incident directly relates to abuse of a child or vulnerable
adult, including:
(A) actual or threatened, nonaccidental physical [
or
]
,
 mental
, or financial
 harm;
(B) sexual abuse;
(C) sexual exploitation; or
(D) negligent treatment;
(vii) any evidence provided by the applicant of rehabilitation, counseling, psychiatric
treatment received, or additional academic or vocational schooling completed; [
and
]
(viii) the applicant's risk of harm to clientele in the program or in the capacity for
which the applicant is applying; and
[
(viii)
] 
(ix)
 any other pertinent information 
presented to or publicly available to the
committee members
.
(c) At the conclusion of the comprehensive review described in Subsection (6)(a), the
office shall deny an application to an applicant if the office finds that approval would likely
create a risk of harm to a child or a vulnerable adult.
(d) At the conclusion of the comprehensive review described in Subsection (6)(a), the
office may not deny an application to an applicant solely because the applicant was convicted
of an offense that occurred 10 or more years before the day on which the applicant submitted
the information required under Subsection (2)(a) if:
(i) the applicant has not committed another misdemeanor or felony offense after the
day on which the conviction occurred; and
(ii) the applicant has never been convicted of an offense described in Subsection
(14)(c).
[
(d)
] 
(e)
 In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
Act, the office may make rules, consistent with this chapter, to establish procedures for the
comprehensive review described in this Subsection (6).
(7) Subject to Subsection (10), the office shall approve an application to an applicant
who is not denied under Subsection (5), (6), or (13).
(8) (a) The office may conditionally approve an application of an applicant, for a
maximum of 60 days after the day on which the office sends written notice to the applicant
under Subsection (12), without requiring that the applicant be directly supervised, if the office:
(i) is awaiting the results of the criminal history search of national criminal background
databases; and
(ii) would otherwise approve an application of the applicant under Subsection (7).
(b) The office may conditionally approve an application of an applicant, for a
maximum of one year after the day on which the office sends written notice to the applicant
under Subsection (12), without requiring that the applicant be directly supervised if the office:
(i) is awaiting the results of an out-of-state registry for providers other than foster and
adoptive parents; and
(ii) would otherwise approve an application of the applicant under Subsection (7).
[
(b)
] 
(c)
 Upon receiving the results of the criminal history search of 
a
 national criminal
background [
databases
] 
database
, the office shall approve or deny the application of the
applicant in accordance with Subsections (5) through (7).
(9) A licensee or department contractor may not permit an individual to have direct
access to a child or a vulnerable adult unless, subject to Subsection (10):
(a) the individual is associated with the licensee or department contractor and:
(i) the individual's application is approved by the office under this section;
(ii) the individual's application is conditionally approved by the office under
Subsection (8); or
(iii) (A) the individual has submitted the background check information described in
Subsection (2) to the office;
(B) the office has not determined whether to approve the applicant's application; and
(C) the individual is directly supervised by an individual who has a current background
screening approval issued by the office under this section and is associated with the licensee or
department contractor;
(b) (i) the individual is associated with the licensee or department contractor;
(ii) the individual has a current background screening approval issued by the office
under this section;
(iii) one of the following circumstances, that the office has not yet reviewed under
Subsection (6), applies to the individual:
(A) the individual was charged with an offense described in Subsection (5)(a);
(B) the individual is listed in the Licensing Information System, described in Section
62A-4a-1006
;
(C) the individual is listed in the vulnerable adult abuse, neglect, or exploitation
database, described in Section 
62A-3-311.1
;
(D) the individual has a record in the juvenile court of a substantiated finding of severe
child abuse or neglect, described in Section 
78A-6-323
; or
(E) the individual has a record of an adjudication in juvenile court for an act that, if
committed by an adult, would be a felony or a misdemeanor 
as described in Subsection (5)(a)
or (6)
; and
(iv) the individual is directly supervised by an individual who:
(A) has a current background screening approval issued by the office under this
section; and
(B) is associated with the licensee or department contractor;
(c) the individual:
(i) is not associated with the licensee or department contractor; and
(ii) is directly supervised by an individual who:
(A) has a current background screening approval issued by the office under this
section; and
(B) is associated with the licensee or department contractor;
(d) the individual is the parent or guardian of the child, or the guardian of the
vulnerable adult;
(e) the individual is approved by the parent or guardian of the child, or the guardian of
the vulnerable adult, to have direct access to the child or the vulnerable adult;
(f) the individual is only permitted to have direct access to a vulnerable adult who
voluntarily invites the individual to visit; or
(g) the individual only provides incidental care for a foster child on behalf of a foster
parent who has used reasonable and prudent judgment to select the individual to provide the
incidental care for the foster child. 
(10) An individual may not have direct access to a child or a vulnerable adult if the
individual is prohibited by court order from having that access.
(11) Notwithstanding any other provision of this section, an individual for whom the
office denies an application may not have [
supervised or unsupervised
] direct access to a child
or vulnerable adult unless the office approves a subsequent application by the individual.
(12) (a) Within 30 days after the day on which the office receives the background
check information for an applicant, the office shall give [
written
] notice 
of the clearance status
to:
(i) the applicant, and the licensee or department contractor, of the office's decision
regarding the background check and findings; and
(ii) the applicant of any convictions and potentially disqualifying charges and
adjudications found in the search.
(b) With the notice described in Subsection (12)(a), the office shall also give the
applicant the details of any comprehensive review conducted under Subsection (6).
(c) If the notice under Subsection (12)(a) states that the applicant's application is
denied, the notice shall further advise the applicant that the applicant may, under Subsection
62A-2-111
(2), request a hearing in the department's Office of Administrative Hearings, to
challenge the office's decision.
(d) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
office shall make rules, consistent with this chapter:
(i) defining procedures for the challenge of [
its
] 
the office's
 background check decision
described in Subsection (12)(c); and
(ii) expediting the process for renewal of a license under the requirements of this
section and other applicable sections.
(13) An individual or a department contractor who provides services in an adults only
substance use disorder program, as defined by rule, is exempt from this section. This
exemption does not extend to a program director or a member, as defined by Section
62A-2-108
, of the program. 
(14) (a) Except as provided in Subsection (14)(b), in addition to the other requirements
of this section, if the background check of an applicant is being conducted for the purpose of
[
licensing a
] 
giving clearance status to an applicant seeking a position in a congregate care
facility, an applicant for a one-time adoption, an applicant seeking to provide a
 prospective
foster home [
or approving
]
, or an applicant seeking to provide
 a prospective adoptive
[
placement of a child in state custody
] 
home
, the office shall:
(i) check the child abuse and neglect registry in each state where each applicant resided
in the five years immediately preceding the day on which the applicant applied to be a foster
parent or adoptive parent, to determine whether the prospective foster parent or prospective
adoptive parent is listed in the registry as having a substantiated or supported finding of child
abuse or neglect; and
(ii) check the child abuse and neglect registry in each state where each adult living in
the home of the applicant described in Subsection (14)(a)(i) resided in the five years
immediately preceding the day on which the applicant applied to be a foster parent or adoptive
parent, to determine whether the adult is listed in the registry as having a substantiated or
supported finding of child abuse or neglect.
(b) The requirements described in Subsection (14)(a) do not apply to the extent that:
(i) federal law or rule permits otherwise; or
(ii) the requirements would prohibit the Division of Child and Family Services or a
court from placing a child with:
(A) a noncustodial parent under Section 
62A-4a-209
, 
78A-6-307
, or 
78A-6-307.5
; or
(B) a relative, other than a noncustodial parent, under Section 
62A-4a-209
, 
78A-6-307
,
or 
78A-6-307.5
, pending completion of the background check described in Subsection (5).
(c) Notwithstanding Subsections (5) through (9), the office shall deny a [
license or a
license renewal to a
] 
clearance to an applicant seeking a position in a congregate care facility,
an applicant for a one-time adoption, an applicant to become a
 prospective foster parent [
or a
]
,
or an applicant to become a
 prospective adoptive parent if the applicant has been convicted of:
(i) a felony involving conduct that constitutes any of the following:
(A) child abuse, as described in Section 
76-5-109
;
(B) commission of domestic violence in the presence of a child, as described in Section
76-5-109.1
;
(C) abuse or neglect of a child with a disability, as described in Section 
76-5-110
;
(D) endangerment of a child or vulnerable adult, as described in Section 
76-5-112.5
;
(E) aggravated murder, as described in Section 
76-5-202
;
(F) murder, as described in Section 
76-5-203
;
(G) manslaughter, as described in Section 
76-5-205
;
(H) child abuse homicide, as described in Section 
76-5-208
;
(I) homicide by assault, as described in Section 
76-5-209
;
(J) kidnapping, as described in Section 
76-5-301
;
(K) child kidnapping, as described in Section 
76-5-301.1
;
(L) aggravated kidnapping, as described in Section 
76-5-302
;
(M) human trafficking of a child, as described in Section 
76-5-308.5
;
(N) an offense described in Title 76, Chapter 5, Part 4, Sexual Offenses;
(O) sexual exploitation of a minor, as described in Section 
76-5b-201
;
(P) aggravated arson, as described in Section 
76-6-103
;
(Q) aggravated burglary, as described in Section 
76-6-203
;
(R) aggravated robbery, as described in Section 
76-6-302
; or
(S) domestic violence, as described in Section 
77-36-1
; or
(ii) an offense committed outside the state that, if committed in the state, would
constitute a violation of an offense described in Subsection (14)(c)(i).
(d) Notwithstanding Subsections (5) through (9), the office shall deny a license or
license renewal to a prospective foster parent or a prospective adoptive parent if, within the five
years immediately preceding the day on which the individual's application or license would
otherwise be approved, the applicant was convicted of a felony involving conduct that
constitutes a violation of any of the following:
(i) aggravated assault, as described in Section 
76-5-103
;
(ii) aggravated assault by a prisoner, as described in Section 
76-5-103.5
;
(iii) mayhem, as described in Section 
76-5-105
;
(iv) an offense described in Title 58, Chapter 37, Utah Controlled Substances Act;
(v) an offense described in Title 58, Chapter 37a, Utah Drug Paraphernalia Act;
(vi) an offense described in Title 58, Chapter 37b, Imitation Controlled Substances
Act;
(vii) an offense described in Title 58, Chapter 37c, Utah Controlled Substance
Precursor Act; or
(viii) an offense described in Title 58, Chapter 37d, Clandestine Drug Lab Act.
(e) In addition to the circumstances described in Subsection (6)(a), the office shall
conduct the comprehensive review of an applicant's background check pursuant to this section
if the registry check described in Subsection (14)(a) indicates that the individual is listed in a
child abuse and neglect registry of another state as having a substantiated or supported finding
of a severe type of child abuse or neglect as defined in Section 
62A-4a-1002
.
Section 17. Section 
62A-15-629
 is amended to read:
62A-15-629.
Temporary commitment -- Requirements and procedures.
(1) An adult shall be temporarily, involuntarily committed to a local mental health
authority upon:
(a) a written application that:
(i) is completed by a responsible individual who has reason to know, stating a belief
that the adult, due to mental illness, is likely to pose substantial danger to self or others if not
restrained and stating the personal knowledge of the adult's condition or circumstances that
lead to the individual's belief; and
(ii) includes a certification by a licensed physician or designated examiner stating that
the physician or designated examiner has examined the adult within a three-day period
immediately preceding that certification, and that the physician or designated examiner is of the
opinion that, due to mental illness, the adult poses a substantial danger to self or others; or
(b) a peace officer or a mental health officer:
(i) observing an adult's conduct that gives the peace officer or mental health officer
probable cause to believe that:
(A) the adult has a mental illness; and
(B) because of the adult's mental illness and conduct, the adult poses a substantial
danger to self or others; and
(ii) completing a temporary commitment application that:
(A) is on a form prescribed by the division;
(B) states the peace officer's or mental health officer's belief that the adult poses a
substantial danger to self or others;
(C) states the specific nature of the danger;
(D) provides a summary of the observations upon which the statement of danger is
based; and
(E) provides a statement of the facts that called the adult to the peace officer's or
mental health officer's attention.
(2) If at any time a patient committed under this section no longer meets the
commitment criteria described in Subsection (1), the local mental health authority or the local
mental health authority's designee shall document the change and release the patient.
(3) A patient committed under this section may be held for a maximum of 24 hours
after commitment, excluding Saturdays, Sundays, and legal holidays, unless:
(a) as described in Section 
62A-15-631
, an application for involuntary commitment is
commenced, which may be accompanied by an order of detention described in Subsection
62A-15-631
(4); or
(b) the patient makes a voluntary application for admission.
(4) Upon a written application described in Subsection (1)(a) or the observation and
belief described in Subsection (1)(b)(i), the adult shall be:
(a) taken into a peace officer's protective custody, by reasonable means, if necessary for
public safety; and
(b) transported for temporary commitment to a facility designated by the local mental
health authority, by means of:
(i) an ambulance, if the adult meets any of the criteria described in Section 
26-8a-305
;
(ii) an ambulance, if a peace officer is not necessary for public safety, and
transportation arrangements are made by a physician, designated examiner, or mental health
officer;
(iii) the city, town, or municipal law enforcement authority with jurisdiction over the
location where the individual to be committed is present, if the individual is not transported by
ambulance; [
or
]
(iv) the county sheriff, if the designated facility is outside of the jurisdiction of the law
enforcement authority described in Subsection (4)(b)(iii) and the individual is not transported
by ambulance[
.
]
; or
(v) nonemergency secured behavioral health transport as that term is defined in Section
26-8a-102
.
(5) Notwithstanding Subsection (4):
(a) an individual shall be transported by ambulance to an appropriate medical facility
for treatment if the individual requires physical medical attention;
(b) if an officer has probable cause to believe, based on the officer's experience and
de-escalation training that taking an individual into protective custody or transporting an
individual for temporary commitment would increase the risk of substantial danger to the
individual or others, a peace officer may exercise discretion to not take the individual into
custody or transport the individual, as permitted by policies and procedures established by the
officer's law enforcement agency and any applicable federal or state statute, or case law; and
(c) if an officer exercises discretion under Subsection (4)(b) to not take an individual
into protective custody or transport an individual, the officer shall document in the officer's
report the details and circumstances that led to the officer's decision.
(6) Title 63G, Chapter 7, Governmental Immunity Act of Utah, applies to this section.
This section does not create a special duty of care.
Section 18. 
Repealer.
This bill repeals:
Section 
26-18-404
,
Home and community-based long-term care -- Room and board
assistance.
Section 
26-40-116
,
Program to encourage appropriate emergency room use --
Application for waivers.
Section 19. 
 Coordinating H.B. 436 with H.B. 137 -- Superseding technical and
substantive amendments.
If this H.B. 436 and H.B. 137, Child Placement Background Check Limits, both pass
and become law, it is the intent of the Legislature that the amendments to Section 
62A-2-120
 in
this H.B. 436 supersede the amendments to Section 
62A-2-120
 in H.B. 137 when the Office of
Legislative Research and General Counsel prepares the Utah Code database for publication.