Single Payer Health Insurance Amendments

155
17-63-706
26B-2-101
26B-2-201
26B-2-206
26B-3-104.1
26B-3-908
26B-4-701
26C-1-101
26C-1-102
26C-1-103
26C-1-104
26C-2-101
26C-2-102
26C-2-103
26C-2-104
26B-1-425
26B-4-705
26B-4-706
26B-4-707
26B-4-708
26B-4-709
26B-4-711
26B-4-712
26C-3-101
26C-3-102
26C-4-101
26C-4-102
26C-5-101
49-20-416
49-20-418
49-20-419
49-20-420
49-20-422
26C-6-101
26C-6-102
49-20-406
31A-22-605.5
31A-22-613.5
31A-22-626
31A-22-635
31A-22-647
31A-22-654
31A-22-656
31A-22-663
31A-46-311
49-20-101
49-20-102
49-20-103
49-20-104
49-20-105
49-20-201
49-20-202
49-20-301
49-20-401
49-20-402
49-20-403
49-20-405
49-20-407
49-20-407.1
49-20-409
49-20-410
49-20-413
49-20-414
49-20-417
49-20-421
49-20-501
49-20-502
49-20-503
49-21-105
53-2d-703
53-17-201
53G-11-203
53H-3-505
58-1-112
58-17b-802
58-37-6.5
59-35-101
59-35-102
59-35-103
59-35-104
59-35-105
59-35-106
59-35-107
59-35-108
59-35-109
63A-17-804
63C-31-102
63E-1-102
63G-2-103
63H-9-101
63I-1-226
63I-2-249
63J-1-602.2
63J-7-102
64-13-30
67-19d-201.5
49-20-404
0
Single Payer Health Insurance Amendments
2026 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Nate Blouin
House Sponsor:
LONG TITLE
General Description:
This bill establishes a state operated health financing program.
Highlighted Provisions:
This bill:
establishes a state operated health financing program;
creates the Utah Health Services Commission;
establishes duties for the Utah Health Services Commission;
moves health workforce councils and offices from the Department of Health and Human
Services to the Utah Health Services Commission;
directs the Department of Health and Human Services to begin transitioning the operation
and management of the Medicaid program to the state operated health financing
program;
transitions the Public Employees' Benefit and Insurance Program into a state operated
health financing program that is open to the public;
allows all state residents to enroll in the state operated health financing program;
prohibits billing by health care facilities;
requires the state operated health financing program to begin billing on behalf of health
care facilities;
requires all government entities to transition government employees to the state operated
health financing program;
repeals certain unnecessary or obsolete programs; and
creates a tax to fund the state operated health financing program.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides a special effective date.
Utah Code Sections Affected:
AMENDS:
17-63-706
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2025,
First Special Session, Chapter 13
26B-2-101
Effective
01/01/28
, as last amended by Laws of Utah 2025, First Special
Session, Chapter 16
26B-2-201
Effective
01/01/27
, as last amended by Laws of Utah 2024, Chapters 113,
240
26B-2-206
Effective
01/01/27
, as last amended by Laws of Utah 2024, Chapter 313
26B-3-908
Effective
01/01/27
, as renumbered and amended by Laws of Utah 2023,
Chapter 306
31A-22-605.5
Effective
01/01/28
, as last amended by Laws of Utah 2012, Chapter 127
31A-22-613.5
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapter 327
31A-22-635
Effective
01/01/28
, as last amended by Laws of Utah 2017, Chapter 292
31A-22-647
Effective
01/01/28
, as enacted by Laws of Utah 2018, Chapter 181
31A-22-654
Effective
01/01/28
, as last amended by Laws of Utah 2021, Chapter 252
31A-46-311
Effective
01/01/28
, as enacted by Laws of Utah 2025, Chapter 514
49-21-105
Effective
01/01/28
, as last amended by Laws of Utah 2013, Chapter 66
53-2d-703
Effective
01/01/28
, as last amended by Laws of Utah 2025, Chapter 240
53-17-201
Effective
01/01/28
, as last amended by Laws of Utah 2025, Chapter 56
58-1-112
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapter 328
58-17b-802
Effective
01/01/28
, as last amended by Laws of Utah 2016, Chapter 159
58-37-6.5
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapter 329
63A-17-804
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2021,
Chapter 344
63C-31-102
Effective
01/01/28
Repealed
07/01/28
, as enacted by Laws of Utah 2023,
Chapter 489
63E-1-102
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapters 16,
431 and 502
63G-2-103
Effective
01/01/28
, as last amended by Laws of Utah 2025, First Special
Session, Chapter 17
63H-9-101
Effective
01/01/28
, as last amended by Laws of Utah 2025, First Special
Session, Chapters 9, 11
63I-1-226
Effective
01/01/28
, as last amended by Laws of Utah 2025, Chapters 47, 277
and 366
63I-2-249
Effective
01/01/28
, as last amended by Laws of Utah 2024, Chapter 385
63J-1-602.2
Effective
01/01/28
Partially Repealed
07/01/29
, as last amended by Laws
of Utah 2025, First Special Session, Chapter 17
63J-7-102
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapters 330,
502
64-13-30
Effective
01/01/28
, as last amended by Laws of Utah 2016, Chapter 243
67-19d-201.5
Effective
01/01/28
, as enacted by Laws of Utah 2012, Chapter 376
ENACTS:
26B-3-104.1
Effective
01/01/27
, Utah Code Annotated 1953
26C-1-101
Effective
07/01/27
, Utah Code Annotated 1953
26C-1-102
Effective
07/01/27
, Utah Code Annotated 1953
26C-1-103
Effective
07/01/27
, Utah Code Annotated 1953
26C-1-104
Effective
07/01/27
, Utah Code Annotated 1953
26C-2-101
Effective
07/01/27
, Utah Code Annotated 1953
26C-2-102
Effective
07/01/27
, Utah Code Annotated 1953
26C-2-103
Effective
07/01/27
, Utah Code Annotated 1953
26C-2-104
Effective
07/01/27
, Utah Code Annotated 1953
26C-3-101
Effective
07/01/27
, Utah Code Annotated 1953
26C-3-102
Effective
01/01/28
, Utah Code Annotated 1953
26C-4-101
Effective
01/01/28
, Utah Code Annotated 1953
26C-4-102
Effective
01/01/28
, Utah Code Annotated 1953
26C-5-101
Effective
01/01/28
, Utah Code Annotated 1953
26C-6-101
Effective
01/01/28
, Utah Code Annotated 1953
26C-6-102
Effective
01/01/28
, Utah Code Annotated 1953
31A-22-663
Effective
01/01/28
, Utah Code Annotated 1953
59-35-101
Effective
01/01/28
, Utah Code Annotated 1953
59-35-102
Effective
01/01/28
, Utah Code Annotated 1953
59-35-103
Effective
01/01/28
, Utah Code Annotated 1953
59-35-104
Effective
01/01/28
, Utah Code Annotated 1953
59-35-105
Effective
01/01/28
, Utah Code Annotated 1953
59-35-106
Effective
01/01/28
, Utah Code Annotated 1953
59-35-107
Effective
01/01/28
, Utah Code Annotated 1953
59-35-108
Effective
01/01/28
, Utah Code Annotated 1953
59-35-109
Effective
01/01/28
, Utah Code Annotated 1953
RENUMBERS AND AMENDS:
26C-2-105
Effective
07/01/27
Repealed
07/01/27
, (Renumbered from 26B-1-425,
as last amended by Laws of Utah 2024, Chapter 245)
26C-2-106
Effective
07/01/27
, (Renumbered from 26B-4-705, as last amended by
Laws of Utah 2025, First Special Session, Chapter 9)
26C-2-107
Effective
07/01/27
, (Renumbered from 26B-4-706, as last amended by
Laws of Utah 2023, Chapter 139 and renumbered and amended by Laws of Utah 2023,
Chapter 307)
26C-2-108
Effective
07/01/27
, (Renumbered from 26B-4-707, as renumbered and
amended by Laws of Utah 2023, Chapter 307)
26C-2-109
Effective
07/01/27
, (Renumbered from 26B-4-708, as renumbered and
amended by Laws of Utah 2023, Chapter 307)
26C-2-110
Effective
07/01/27
, (Renumbered from 26B-4-709, as renumbered and
amended by Laws of Utah 2023, Chapter 307)
26C-2-111
Effective
07/01/27
, (Renumbered from 26B-4-711, as last amended by
Laws of Utah 2024, Chapters 250, 303)
26C-2-112
Effective
07/01/27
, (Renumbered from 26B-4-712, as last amended by
Laws of Utah 2024, Chapter 303)
26C-5-102
Effective
01/01/28
, (Renumbered from 49-20-416, as enacted by Laws of
Utah 2017, Chapter 180)
26C-5-103
Effective
01/01/28
, (Renumbered from 49-20-418, as last amended by
Laws of Utah 2025, Chapter 52)
26C-5-104
Effective
01/01/28
, (Renumbered from 49-20-419, as enacted by Laws of
Utah 2019, Chapter 320)
26C-5-105
Effective
01/01/28
Partially Repealed
01/01/30
, (Renumbered from
49-20-420, as enacted by Laws of Utah 2020, Chapter 187)
26C-5-106
Effective
01/01/28
Repealed
07/01/27
, (Renumbered from 49-20-422,
as enacted by Laws of Utah 2023, Chapter 292)
26C-7-101
Effective
01/01/28
, (Renumbered from 49-20-406, as last amended by
Laws of Utah 2025, Chapter 56)
67-19d-201.6
Effective
01/01/28
, (Renumbered from 49-20-404, as last amended by
Laws of Utah 2013, Chapter 410)
REPEALS:
26B-4-701
Effective
07/01/27
, as last amended by Laws of Utah 2025, First Special
Session, Chapter 16
31A-22-626
Effective
01/01/28
, as last amended by Laws of Utah 2020, Chapter 310
31A-22-656
Effective
01/01/28
, as enacted by Laws of Utah 2021, Chapter 255
49-20-101
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2002,
Chapter 250
49-20-102
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2002,
Chapter 250
49-20-103
Effective
01/01/28
, as last amended by Laws of Utah 2017, Chapter 141
49-20-104
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2002,
Chapter 250
49-20-105
Effective
01/01/28
, as last amended by Laws of Utah 2012, Chapter 406
49-20-201
Effective
01/01/28
, as last amended by Laws of Utah 2024, Chapter 138
49-20-202
Effective
01/01/28
, as last amended by Laws of Utah 2025, First Special
Session, Chapter 9
49-20-301
Effective
01/01/28
, as last amended by Laws of Utah 2003, Chapter 240
49-20-401
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapters 194,
328
49-20-402
Effective
01/01/28
, as last amended by Laws of Utah 2007, Chapter 130
49-20-403
Effective
01/01/28
, as enacted by Laws of Utah 2002, Chapter 250
49-20-405
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2002,
Chapter 250
49-20-407
Effective
01/01/28
, as last amended by Laws of Utah 2017, Chapter 292
49-20-407.1
Effective
01/01/28
, as enacted by Laws of Utah 2025, Chapter 55
49-20-409
Effective
01/01/28
, as last amended by Laws of Utah 2007, Chapter 130
49-20-410
Effective
01/01/28
, as last amended by Laws of Utah 2021, Chapters 344,
382
49-20-413
Effective
01/01/28
, as enacted by Laws of Utah 2015, Chapter 68
49-20-414
Effective
01/01/28
, as last amended by Laws of Utah 2023, Chapter 328
49-20-417
Effective
01/01/28
, as enacted by Laws of Utah 2017, Chapter 349
49-20-421
Effective
01/01/28
, as last amended by Laws of Utah 2025, Chapter 122
49-20-501
Effective
01/01/28
, as enacted by Laws of Utah 2011, Chapter 83
49-20-502
Effective
01/01/28
, as last amended by Laws of Utah 2021, Chapter 340
49-20-503
Effective
01/01/28
, as last amended by Laws of Utah 2012, Chapter 265
53G-11-203
Effective
01/01/28
, as last amended by Laws of Utah 2019, Chapter 293
53H-3-505
Effective
01/01/28
, as renumbered and amended by Laws of Utah 2025,
First Special Session, Chapter 8
Be it enacted by the Legislature of the state of Utah:
Section 1. Section
17-63-706
is amended to read:
17-63-706
Effective
01/01/28
. County charges enumerated.
(1)
County charges are:
(a)
charges incurred against the county by any law;
(b)
the necessary expenses of the county attorney or district attorney incurred in criminal
cases arising in the county, and all other expenses necessarily incurred by the county
or district attorney in the prosecution of criminal cases, except jury and witness fees;
(c)
the expenses of health care as described in Section
17-72-501
, and other expenses
necessarily incurred in the support of prisoners committed to the county jail, except
as provided in Subsection
(2)
;
(d)
for a county not within the state district court administrative system, the sum
required by law to be paid jurors in civil cases;
(e)
all charges and accounts for services rendered by any justice court judge for services
in the trial and examination of persons charged with a criminal offense not otherwise
provided for by law;
(f)
the contingent expenses necessarily incurred for the use and benefit of the county;
(g)
every other sum directed by law to be raised for any county purposes under the
direction of the county legislative body or declared a county charge;
(h)
the fees of constables for services rendered in criminal cases;
(i)
the necessary expenses of the sheriff and deputies incurred in civil and criminal cases
arising in the county, and all other expenses necessarily incurred by the sheriff and
deputies in performing the duties imposed upon the sheriff and deputies by law;
(j)
the sums required by law to be paid by the county to jurors and witnesses serving at
inquests and in criminal cases in justice courts; and
(k)
subject to Subsection
(2)
, expenses incurred by a health care facility or health care
provider in providing health care services, treatment, hospitalization, or related
transportation, at the request of a county sheriff for:
(i)
prisoners booked into a county jail on a charge of a criminal offense; or
(ii)
inmates convicted of a criminal offense and committed to a county jail.
(2)
(a)
Expenses described in Subsections
(1)(c)
and
(1)(k)
are a charge to the county
only to the extent that the charge exceeds any private insurance in effect that covers
the expenses described in Subsections
(1)(c)
and
(1)(k)
.
(b)
The county may collect costs of health care, treatment, hospitalization, and related
transportation provided to a person described in Subsection
(1)(k)
who has the
resources or the ability to pay, subject to the following priorities for payment:
(i)
first priority shall be given to restitution; and
(ii)
second priority shall be given to family support obligations.
(c)
A county may seek reimbursement from a prisoner or inmate described in Subsection
(1)(k)
for expenses incurred by the county in behalf of the prisoner or inmate for
health care, treatment, hospitalization, or related transportation by:
(i)
deducting the cost from the prisoner's or inmate's cash account on deposit with the
detention facility during the prisoner's or inmate's incarceration or during a
subsequent incarceration if:
(A)
the subsequent incarceration occurs within the same county; and
(B)
the incarceration is within 10 years of the date of the expense in behalf of the
prisoner or inmate;
(ii)
placing a lien for the amount of the expense against the prisoner's or inmate's
personal property held by the jail; and
(iii)
adding the amount of expenses incurred to any other amount owed by the
prisoner or inmate to the jail upon the prisoner's or inmate's release in accordance
with Subsection
76-3-201(4)(c)
.
(d)
(i)
A jail shall ensure that each prisoner or inmate is enrolled in the Utah Cares
Health Financing Program, created in Title 26C, Utah Cares Act, to cover health
care expenses if the inmate is eligible for enrollment when enrollment opens on
January 1, 2029.
(ii)
A prisoner or inmate who receives health care, treatment, hospitalization, or
related transportation shall cooperate with the jail facility seeking payment or
reimbursement under this section for the prisoner's or inmate's expenses.
(e)
If there is no contract between a county jail and a health care facility or health care
provider that establishes a fee schedule for services rendered
or the individual is not
an enrollee described in Subsection
(2)(d)(i)
, expenses under Subsection
(1)(k)
shall
be commensurate with:
(i)
for a health care facility, the current noncapitated state Medicaid rates; and
(ii)
for a health care provider, 65% of the amount that would be paid to the health
care provider:
(A)
under the
Public Employees' Benefit and Insurance Program
Utah Cares
Health Financing Program
, created in
Section
49-20-103
Title 26C, Utah
Cares Act
; and
(B)
if the person receiving the health care service were
a covered employee under
the Public Employees' Benefit and Insurance Program
an enrollee of the Utah
Cares Health Financing Program
.
(f)
Subsection
(1)(k)
does not apply to expenses of an individual held at the county jail
at the request of an agency of the United States.
(g)
A county that receives information from the Public Employees' Benefit and
Insurance Program to enable the county to
The Utah Cares Health Financing
Program shall
calculate the amount to be paid to a health care provider under
Subsection
(2)(e)(ii)
shall keep that information confidential
.
Section 2. Section
26B-2-101
is amended to read:
26B-2-101
Effective
01/01/28
. Definitions.
As used in this part:
(1)
"Abuse" means the same as that term is defined in Section
80-1-102
.
(2)
"Adoption services" means the same as that term is defined in Section
80-2-801
.
(3)
"Adult day care" means nonresidential care and supervision:
(a)
for three or more adults for at least four but less than 24 hours a day; and
(b)
that meets the needs of functionally impaired adults through a comprehensive
program that provides a variety of health, social, recreational, and related support
services in a protective setting.
(4)
"Applicant" means a person that applies for an initial license or a license renewal under
this part.
(5)
(a)
"Associated with the licensee" means that an individual is:
(i)
affiliated with a licensee as an owner, director, member of the governing body,
employee, agent, provider of care, department contractor, or volunteer; or
(ii)
applying to become affiliated with a licensee in a capacity described in
Subsection
(5)(a)(i)
.
(b)
"Associated with the licensee" does not include:
(i)
service on the following bodies, unless that service includes direct access to a
child or a vulnerable adult:
(A)
a local mental health authority described in Section
17-77-301
;
(B)
a local substance abuse authority described in Section
17-77-201
; or
(C)
a board of an organization operating under a contract to provide mental health
or substance use programs, or services for the local mental health authority or
substance abuse authority; or
(ii)
a guest or visitor whose access to a child or a vulnerable adult is directly
supervised at all times.
(6)
"Behavioral health receiving center" means a 23-hour non-secure program or facility
that is responsible for, and provides mental health crisis services to, an individual
experiencing a mental health crisis.
(7)
(a)
"Boarding school" means a private school that:
(i)
uses a regionally accredited education program;
(ii)
provides a residence to the school's students:
(A)
for the purpose of enabling the school's students to attend classes at the
school; and
(B)
as an ancillary service to educating the students at the school;
(iii)
has the primary purpose of providing the school's students with an education, as
defined in Subsection
(7)(b)(i)
; and
(iv)
(A)
does not provide the treatment or services described in Subsection
(49)(a)
;
or
(B)
provides the treatment or services described in Subsection
(49)(a)
on a limited
basis, as described in Subsection
(7)(b)(ii)
.
(b)
(i)
For purposes of Subsection
(7)(a)(iii)
, "education" means a course of study for
one or more grades from kindergarten through grade 12.
(ii)
For purposes of Subsection
(7)(a)(iv)(B)
, a private school provides the treatment
or services described in Subsection
(49)(a)
on a limited basis if:
(A)
the treatment or services described in Subsection
(49)(a)
are provided only as
an incidental service to a student; and
(B)
the school does not:
(I)
specifically solicit a student for the purpose of providing the treatment or
services described in Subsection
(49)(a)
; or
(II)
have a primary purpose of providing the treatment or services described in
Subsection
(49)(a)
.
(c)
"Boarding school" does not include a therapeutic school.
(8)
"Certification" means a less restrictive level of licensure issued by the department.
(9)
"Child" means an individual under 18 years old.
(10)
"Child placing" means receiving, accepting, or providing custody or care for any child,
temporarily or permanently, for the purpose of:
(a)
finding a person to adopt the child;
(b)
placing the child in a home for adoption; or
(c)
foster home placement.
(11)
"Child-placing agency" means a person that engages in child placing.
(12)
"Client" means an individual who receives or has received services from a licensee.
(13)
(a)
"Congregate care program" means any of the following that provide services to a
child:
(i)
an outdoor youth program;
(ii)
a residential support program;
(iii)
a residential treatment program; or
(iv)
a therapeutic school.
(b)
"Congregate care program" does not include a human services program that:
(i)
is licensed to serve adults; and
(ii)
is approved by the office to service a child for a limited time.
(14)
"Day treatment" means specialized treatment that is provided to:
(a)
a client less than 24 hours a day; and
(b)
four or more persons who:
(i)
are unrelated to the owner or provider; and
(ii)
have emotional, psychological, developmental, physical, or behavioral
dysfunctions, impairments, or chemical dependencies.
(15)
"Department contractor" means an individual who:
(a)
provides services under a contract with the department; and
(b)
due to the contract with the department, has or will likely have direct access to a
child or vulnerable adult.
(16)
"Direct access" means that an individual has, or likely will have:
(a)
contact with or access to a child or vulnerable adult that provides the individual with
an opportunity for personal communication or touch; or
(b)
an opportunity to view medical, financial, or other confidential personal identifying
information of the child, the child's parents or legal guardians, or the vulnerable adult.
(17)
"Directly supervised" means that an individual is being supervised under the
uninterrupted visual and auditory surveillance of another individual who has a current
background check approval issued by the office.
(18)
"Director" means the director of the office.
(19)
"Division" means the Division of Licensing and Background Checks created under
Section
26B-2-103
.
(20)
"Domestic violence" means the same as that term is defined in Section
77-36-1
.
(21)
"Domestic violence treatment program" means a nonresidential program designed to
provide psychological treatment and educational services to perpetrators and victims of
domestic violence.
(22)
"Elder adult" means a person 65 years old or older.
(23)
"Emergency safety intervention" means a tactic used to protect staff or a client from
being physically injured, utilized by an appropriately trained direct care staff and only
performed in accordance with a nationally or regionally recognized curriculum in the
least restrictive manner to restore staff or client safety.
(24)
"Foster home" means a residence that is licensed or certified by the office for the
full-time substitute care of a child.
(25)
"Harm" means the same as that term is defined in Section
80-1-102
.
(26)
"Health benefit plan" means the same as that term is defined in Section
31A-1-301
.
(27)
"Health care provider" means the same as that term is defined in Section
78B-3-403
.
(28)
"Health insurer" means:
(a)
an insurer who offers health care insurance as that term is defined in Section
31A-1-301
;
(b)
health benefits offered
to state employees under Section
49-20-202
under Title 26C,
Utah Cares Act
; and
(c)
a workers' compensation insurer:
(i)
authorized to provide workers' compensation insurance in the state; or
(ii)
that is a self-insured employer as defined in Section
34A-2-201.5
.
(29)
(a)
"Human services program" means:
(i)
a foster home;
(ii)
a therapeutic school;
(iii)
a youth program;
(iv)
an outdoor youth program;
(v)
a residential treatment program;
(vi)
a residential support program;
(vii)
a resource family home;
(viii)
a recovery residence;
(ix)
a behavioral health receiving center; or
(x)
a facility or program that provides:
(A)
adult day care;
(B)
day treatment;
(C)
outpatient treatment;
(D)
domestic violence treatment;
(E)
child-placing services;
(F)
social detoxification; or
(G)
any other human services that are required by contract with the department to
be licensed with the department.
(b)
"Human services program" does not include:
(i)
a boarding school;
(ii)
a residential vocational or life skills program, as defined in Section
13-53-102
; or
(iii)
a short-term relief care provider.
(30)
"Indian child" means the same as that term is defined in 25 U.S.C. Sec. 1903.
(31)
"Indian country" means the same as that term is defined in 18 U.S.C. Sec. 1151.
(32)
"Indian tribe" means the same as that term is defined in 25 U.S.C. Sec. 1903.
(33)
"Intermediate secure treatment" means 24-hour specialized residential treatment or
care for an individual who:
(a)
cannot live independently or in a less restrictive environment; and
(b)
requires, without the individual's consent or control, the use of locked doors to care
for the individual.
(34)
"Licensee" means an individual or a human services program licensed by the office.
(35)
"Local government" means a city, town, or county.
(36)
"Mental health treatment program" means a program that:
(a)
is a structured intervention; and
(b)
is used to improve mental health, prevent mental disorders, and treat mental health
conditions.
(37)
"Medication assisted treatment" means the use of a prescribed medication approved by
the United States Food and Drug Administration, such as buprenorphine, methadone, or
naltrexone, to treat substance use withdrawal symptoms or a substance use disorder.
(38)
"Minor" means child.
(39)
"Office" means, except as provided in Section
26B-2-120
, the Office of Licensing
within the department.
(40)
"Ombudsman" means the congregate care ombudsman created in Section
26B-2-124.2
.
(41)
"Outdoor youth program" means a program that provides:
(a)
services to a child who has:
(i)
a chemical dependency; or
(ii)
a dysfunction or impairment that is emotional, psychological, developmental,
physical, or behavioral;
(b)
a 24-hour outdoor group living environment; and
(c)
(i)
regular therapy, including group, individual, or supportive family therapy; or
(ii)
informal therapy or similar services, including wilderness therapy, adventure
therapy, or outdoor behavioral healthcare.
(42)
"Outpatient treatment" means individual, family, or group therapy or counseling
designed to improve and enhance social or psychological functioning for those whose
physical and emotional status allows them to continue functioning in their usual living
environment.
(43)
"Practice group" or "group practice" means two or more health care providers legally
organized as a partnership, professional corporation, or similar association, for which:
(a)
substantially all of the services of the health care providers who are members of the
group are provided through the group and are billed in the name of the group and
amounts received are treated as receipts of the group; and
(b)
the overhead expenses of and the income from the practice are distributed in
accordance with methods previously determined by members of the group.
(44)
"Private-placement child" means a child whose parent or guardian enters into a
contract with a congregate care program for the child to receive services.
(45)
"Qualifying residential treatment program" means a residential treatment program that
is licensed under this part and:
(a)
is operated as a nonprofit corporation or foreign nonprofit corporation, as those terms
are defined in Section
16-6a-102
; or
(b)
receives any local, state, or federal government funding, government grant money, or
any other form of government assistance to operate or provide services or training in
the ordinary course of business.
(46)
"Qualifying recovery residence" means a recovery residence that is licensed under this
part and:
(a)
is operated as a nonprofit corporation or foreign nonprofit corporation, as those terms
are defined in Section
16-6a-102
; or
(b)
receives any local, state, or federal government funding, government grant money, or
any other form of government assistance to operate or provide services or training in
the ordinary course of business.
(47)
(a)
"Recovery residence" means a home, residence, or facility that meets at least two
of the following requirements:
(i)
provides a supervised living environment for individuals recovering from a
substance use disorder;
(ii)
provides a living environment in which more than half of the individuals in the
residence are recovering from a substance use disorder;
(iii)
provides or arranges for residents to receive services related to the resident's
recovery from a substance use disorder, either on or off site;
(iv)
is held out as a living environment in which individuals recovering from
substance abuse disorders live together to encourage continued sobriety; or
(v)
(A)
receives public funding; or
(B)
is run as a business venture, either for-profit or not-for-profit.
(b)
"Recovery residence" does not mean:
(i)
a residential treatment program;
(ii)
residential support program;
(iii)
a residential vocational or life skills program; or
(iv)
a home, residence, or facility, in which:
(A)
residents, by a majority vote of the residents, establish, implement, and
enforce policies governing the living environment, including the manner in
which applications for residence are approved and the manner in which
residents are expelled;
(B)
residents equitably share rent and housing-related expenses; and
(C)
a landlord, owner, or operator does not receive compensation, other than fair
market rental income, for establishing, implementing, or enforcing policies
governing the living environment.
(48)
"Regular business hours" means:
(a)
the hours during which services of any kind are provided to a client; or
(b)
the hours during which a client is present at the facility of a licensee.
(49)
(a)
"Residential support program" means a program that arranges for or provides the
necessities of life as a protective service to individuals or families who have a
disability or who are experiencing a dislocation or emergency that prevents them
from providing these services for themselves or their families.
(b)
"Residential support program" includes a program that provides a supervised living
environment for individuals with dysfunctions or impairments that are:
(i)
emotional;
(ii)
psychological;
(iii)
developmental; or
(iv)
behavioral.
(c)
Treatment is not a necessary component of a residential support program.
(d)
"Residential support program" does not include:
(i)
a recovery residence; or
(ii)
a program that provides residential services that are performed:
(A)
exclusively under contract with the department and provided to individuals
through the Division of Services for People with Disabilities; or
(B)
in a facility that serves fewer than four individuals.
(50)
(a)
"Residential treatment" means a 24-hour group living environment for four or
more individuals unrelated to the owner or provider that offers room or board and
specialized treatment, behavior modification, rehabilitation, discipline, emotional
growth, or habilitation services for persons with emotional, psychological,
developmental, or behavioral dysfunctions, impairments, or chemical dependencies.
(b)
"Residential treatment" does not include a:
(i)
boarding school;
(ii)
foster home; or
(iii)
recovery residence.
(51)
"Residential treatment program" means a program or facility that provides:
(a)
residential treatment; or
(b)
intermediate secure treatment.
(52)
"Seclusion" means the involuntary confinement of an individual in a room or an area:
(a)
away from the individual's peers; and
(b)
in a manner that physically prevents the individual from leaving the room or area.
(53)
"Short-term relief care provider" means an individual who:
(a)
provides short-term and temporary relief care to a foster parent:
(i)
for less than six consecutive nights; and
(ii)
in the short-term relief care provider's home;
(b)
is an immediate family member or relative, as those terms are defined in Section
80-3-102
, of the foster parent;
(c)
is direct access qualified, as that term is defined in Section
26B-2-120
;
(d)
has been approved to provide short-term relief care by the department;
(e)
is not reimbursed by the department for the temporary relief care provided; and
(f)
is not an immediate family member or relative, as those terms are defined in Section
80-3-102
, of the foster child.
(54)
"Social detoxification" means short-term residential services for persons who are
experiencing or have recently experienced drug or alcohol intoxication, that are provided
outside of a health care facility licensed under Part
2, Health Care Facility Licensing and
Inspection
, and that include:
(a)
room and board for persons who are unrelated to the owner or manager of the facility;
(b)
specialized rehabilitation to acquire sobriety; and
(c)
aftercare services.
(55)
"Substance abuse disorder" or "substance use disorder" mean the same as "substance
use disorder" is defined in Section
26B-5-501
.
(56)
"Substance abuse treatment program" or "substance use disorder treatment program"
means a program:
(a)
designed to provide:
(i)
specialized drug or alcohol treatment;
(ii)
rehabilitation; or
(iii)
habilitation services; and
(b)
that provides the treatment or services described in Subsection
(56)(a)
to persons
with:
(i)
a diagnosed substance use disorder; or
(ii)
chemical dependency disorder.
(57)
"Therapeutic school" means a residential group living facility:
(a)
for four or more individuals that are not related to:
(i)
the owner of the facility; or
(ii)
the primary service provider of the facility;
(b)
that serves students who have a history of failing to function:
(i)
at home;
(ii)
in a public school; or
(iii)
in a nonresidential private school; and
(c)
that offers:
(i)
room and board; and
(ii)
an academic education integrated with:
(A)
specialized structure and supervision; or
(B)
services or treatment related to:
(I)
a disability;
(II)
emotional development;
(III)
behavioral development;
(IV)
familial development; or
(V)
social development.
(58)
"Unrelated persons" means persons other than parents, legal guardians, grandparents,
brothers, sisters, uncles, or aunts.
(59)
"Vulnerable adult" means an elder adult or an adult who has a temporary or permanent
mental or physical impairment that substantially affects the person's ability to:
(a)
provide personal protection;
(b)
provide necessities such as food, shelter, clothing, or mental or other health care;
(c)
obtain services necessary for health, safety, or welfare;
(d)
carry out the activities of daily living;
(e)
manage the adult's own resources; or
(f)
comprehend the nature and consequences of remaining in a situation of abuse,
neglect, or exploitation.
(60)
(a)
"Youth program" means a program designed to provide behavioral, substance
use, or mental health services to minors that:
(i)
serves adjudicated or nonadjudicated youth;
(ii)
charges a fee for the program's services;
(iii)
may provide host homes or other arrangements for overnight accommodation of
the youth;
(iv)
may provide all or part of the program's services in the outdoors;
(v)
may limit or censor access to parents or guardians; and
(vi)
prohibits or restricts a minor's ability to leave the program at any time of the
minor's own free will.
(b)
"Youth program" does not include recreational programs such as Boy Scouts, Girl
Scouts, 4-H, and other such organizations.
(61)
(a)
"Youth transportation company" means any person that transports a child for
payment to or from a congregate care program in Utah.
(b)
"Youth transportation company" does not include:
(i)
a relative of the child;
(ii)
a state agency; or
(iii)
a congregate care program's employee who transports the child from the
congregate care program that employs the employee and returns the child to the
same congregate care program.
Section 3. Section
26B-2-201
is amended to read:
26B-2-201
Effective
01/01/27
. Definitions.
As used in this part:
(1)
"Abortion clinic" means a type I abortion clinic or a type II abortion clinic.
(2)
"Activities of daily living" means essential activities including:
(a)
dressing;
(b)
eating;
(c)
grooming;
(d)
bathing;
(e)
toileting;
(f)
ambulation;
(g)
transferring; and
(h)
self-administration of medication.
(3)
"Ambulatory surgical facility" means a freestanding facility, which provides surgical
services to patients not requiring hospitalization.
(4)
"Assistance with activities of daily living" means providing of or arranging for the
provision of assistance with activities of daily living.
(5)
(a)
"Assisted living facility" means:
(i)
a type I assisted living facility, which is a residential facility that provides
assistance with activities of daily living and social care to two or more residents
who:
(A)
require protected living arrangements; and
(B)
are capable of achieving mobility sufficient to exit the facility without the
assistance of another person; and
(ii)
a type II assisted living facility, which is a residential facility with a home-like
setting that provides an array of coordinated supportive personal and health care
services available 24 hours per day to residents who have been assessed under
department rule to need any of these services.
(b)
Each resident in a type I or type II assisted living facility shall have a service plan
based on the assessment, which may include:
(i)
specified services of intermittent nursing care;
(ii)
administration of medication; and
(iii)
support services promoting residents' independence and self-sufficiency.
(6)
"Birthing center" means a facility that:
(a)
receives maternal clients and provides care during pregnancy, delivery, and
immediately after delivery; and
(b)
(i)
is freestanding; or
(ii)
is not freestanding, but meets the requirements for an alongside midwifery unit
described in Subsection
26B-2-228
(7).
(7)
"Committee" means the Health Facility Committee created in Section
26B-1-204
.
(8)
"Consumer" means any person not primarily engaged in the provision of health care to
individuals or in the administration of facilities or institutions in which such care is
provided and who does not hold a fiduciary position, or have a fiduciary interest in any
entity involved in the provision of health care, and does not receive, either directly or
through his spouse, more than 1/10 of his gross income from any entity or activity
relating to health care.
(9)
"End stage renal disease facility" means a facility which furnishes staff-assisted kidney
dialysis services, self-dialysis services, or home-dialysis services on an outpatient basis.
(10)
"Freestanding" means existing independently or physically separated from another
health care facility by fire walls and doors and administrated by separate staff with
separate records.
(11)
"General acute hospital" means a facility which provides diagnostic, therapeutic, and
rehabilitative services to both inpatients and outpatients by or under the supervision of
physicians.
(12)
"Governmental unit" means the state, or any county, municipality, or other political
subdivision or any department, division, board, or agency of the state, a county,
municipality, or other political subdivision.
(13)
(a)
"Health care facility" means general acute hospitals, specialty hospitals, home
health agencies, hospices, nursing care facilities, residential-assisted living facilities,
birthing centers, ambulatory surgical facilities, small health care facilities, abortion
clinics, facilities owned or operated by health maintenance organizations, end stage
renal disease facilities, and any other health care facility which the committee
designates by rule.
(b)
"Health care facility" does not include the offices of private physicians or dentists,
whether for individual or group practice, except that it does include an abortion clinic.
(14)
"Health maintenance organization" means an organization, organized under the laws of
any state which:
(a)
is a qualified health maintenance organization under 42 U.S.C. Sec. 300e-9; or
(b)
(i)
provides or otherwise makes available to enrolled participants at least the
following basic health care services: usual physician services, hospitalization,
laboratory, x-ray, emergency, and preventive services and out-of-area coverage;
(ii)
is compensated, except for copayments, for the provision of the basic health
services listed in Subsection
(14)(b)(i)
to enrolled participants by a payment
which is paid on a periodic basis without regard to the date the health services are
provided and which is fixed without regard to the frequency, extent, or kind of
health services actually provided;
(iii)
provides physicians' services primarily directly through physicians who are
either employees or partners of such organizations, or through arrangements with
individual physicians or one or more groups of physicians organized on a group
practice or individual practice basis; and
(iv)
provides physician assistant services.
(15)
(a)
"Home health agency" means an agency, organization, or facility or a
subdivision of an agency, organization, or facility which employs two or more direct
care staff persons who provide licensed nursing services, therapeutic services of
physical therapy, speech therapy, occupational therapy, medical social services, or
home health aide services on a visiting basis.
(b)
"Home health agency" does not mean an individual who provides services under the
authority of a private license.
(16)
"Hospice" means a program of care for the terminally ill and their families which
occurs in a home or in a health care facility and which provides medical, palliative,
psychological, spiritual, and supportive care and treatment.
(17)
"Nursing care facility" means a health care facility, other than a general acute or
specialty hospital, constructed, licensed, and operated to provide patient living
accommodations, 24-hour staff availability, and at least two of the following patient
services:
(a)
a selection of patient care services, under the direction and supervision of a registered
nurse, ranging from continuous medical, skilled nursing, psychological, or other
professional therapies to intermittent health-related or paraprofessional personal care
services;
(b)
a structured, supportive social living environment based on a professionally designed
and supervised treatment plan, oriented to the individual's habilitation or
rehabilitation needs; or
(c)
a supervised living environment that provides support, training, or assistance with
individual activities of daily living.
(18)
"Person" means any individual, firm, partnership, corporation, company, association,
or joint stock association, and the legal successor thereof.
(19)
"Resident" means a person 21 years old or older who:
(a)
as a result of physical or mental limitations or age requires or requests services
provided in an assisted living facility; and
(b)
does not require intensive medical or nursing services as provided in a hospital or
nursing care facility.
(20)
"Small health care facility" means a four to 16 bed facility that provides licensed
health care programs and services to residents.
(21)
"Specialty hospital" means a facility which provides specialized diagnostic,
therapeutic, or rehabilitative services in the recognized specialty or specialties for which
the hospital is licensed.
(22)
"Substantial compliance" means in a department survey of a licensee, the department
determines there is an absence of deficiencies which would harm the physical health,
mental health, safety, or welfare of patients or residents of a licensee.
(23)
"Type I abortion clinic" means a facility, including a physician's office, but not
including a general acute or specialty hospital, that:
(a)
performs abortions, as defined in Section
76-7-301
, during the first trimester of
pregnancy; and
(b)
does not perform abortions, as defined in Section
76-7-301
, after the first trimester of
pregnancy.
(24)
"Type II abortion clinic" means a facility, including a physician's office, but not
including a general acute or specialty hospital, that:
(a)
performs abortions, as defined in Section
76-7-301
, after the first trimester of
pregnancy; or
(b)
performs abortions, as defined in Section
76-7-301
, during the first trimester of
pregnancy and after the first trimester of pregnancy.
(25)
"Utah Cares program" means the Utah Cares Health Financing Program created in
Title 26C, Utah Cares Act.
Section 4. Section
26B-2-206
is amended to read:
26B-2-206
Effective
01/01/27
. License required -- Not assignable or
transferable -- Posting -- Expiration and renewal -- Time for compliance by operating
facilities.
(1)
(a)
A person or governmental unit acting severally or jointly with any other person or
governmental unit, may not establish, conduct, or maintain a health care facility in
this state without receiving a license from the department as provided by this part and
the rules

adopted
pursuant to
this part .
(b)
This Subsection
(1)
does not apply to facilities that are exempt under Section
26B-2-205
.
(2)
A license issued under this part is not assignable or transferable.
(3)
The current license shall at all times be posted in each health care facility in a place
readily visible and accessible to the public.
(4)
(a)
The department may issue a license for a period of time not to exceed 12 months
from the date of issuance for an abortion clinic and not to exceed 24 months from the
date of issuance for other health care facilities that meet the provisions of this part
and department rules adopted
pursuant to
this part.
(b)
Each license expires at midnight on the day designated on the license as the
expiration date, unless previously revoked by the department.
(c)
The license shall be renewed upon completion of the application requirements,
unless the department finds the health care facility has not complied with the
provisions of this part or the rules adopted
pursuant to
this part.
(5)
A license may be issued under this section only for the operation of a specific facility at
a specific site by a specific person.
(6)
Any health care facility in operation at the time of adoption of any applicable rules as
provided under this part shall be given a reasonable time for compliance as determined
by the committee.
(7)
(a)
Beginning November 1, 2030, the department may not issue or renew a health
care facility license unless the licensee has:
(i)
agreed to a payment structure described in Section
26C-4-102
with the Utah Cares
program; and
(ii)
authorized the Utah Cares program to conduct all billing operations on behalf of
the health care facility.
(b)
Subsection
(7)(a)
does not apply to a health care facility licensed as a long-term care
facility.
Section 5. Section
26B-3-104.1
is enacted to read:
26B-3-104.1
Effective
01/01/27
. Medicaid transition to Utah Cares Health
Financing Program.
(1)
Notwithstanding any other provision of law, the department shall amend the state plan
and any necessary Medicaid waivers to transition the Medicaid program to using the
Utah Cares Health Financing Program described in Title 26C, Utah Cares Act, for
payment of all Medicaid services.
(2)
The department and the Utah Cares Health Financing Program shall apply for any
waivers and make necessary state plan amendments to transition the Utah Cares Health
Financing Program as the primary entity for maintaining and administering the Medicaid
program, including the state plan.
(3)
When necessary waivers and state plan amendments are approved, the department shall
transition the operation of the Medicaid program and all Medicaid services to the Utah
Cares Health Financing Program.
Section 6. Section
26B-3-908
is amended to read:
26B-3-908
Effective
01/01/27
. Managed care -- Contracting for services.
(1)
Program benefits provided to a member under the program, as described in Section
26B-3-904
, shall be delivered by a managed care organization if the department
determines that adequate services are available where the member lives or resides.
(2)
The department may contract with a managed care organization to provide program
benefits. The department shall evaluate a potential contract with a managed care
organization based on:
(a)
the managed care organization's:
(i)
ability to manage medical expenses, including mental health costs;
(ii)
proven ability to handle accident and health insurance;
(iii)
efficiency of claim paying procedures;
(iv)
proven ability for managed care and quality assurance;
(v)
provider contracting and discounts;
(vi)
pharmacy benefit management;
(vii)
estimated total charges for administering the pool;
(viii)
ability to administer the pool in a cost-efficient manner;
(ix)
ability to provide adequate providers and services in the state; and
(x)
ability to meet quality measures for emergency room use and access to primary
care established by the department under Subsection
26B-3-204(4)
; and
(b)
other factors established by the department.
(3)
The department may enter into separate managed care organization contracts to provide
dental benefits required by Section
26B-3-904
.
(4)
The department's contract with a managed care organization for the program's benefits
shall include risk sharing provisions in which the plan shall accept at least 75% of the
risk for any difference between the department's premium payments per member and
actual medical expenditures.
(5)
Notwithstanding any other provision of law, all program benefits shall be provided by
the Utah Cares Health Financing Program once the department obtains necessary
approval from CMS to provide services through the Utah Cares Health Financing
Program.
(5)
(a)
The department may contract with the Group Insurance Division within the Utah
State Retirement Office to provide services under Subsection
(1)
if no managed care
organization is willing to contract with the department or the department determines
no managed care organization meets the criteria established under Subsection
(2)
.
(b)
In accordance with Section
49-20-201
, a contract awarded under Subsection
(5)(a)

is not subject to the risk sharing required by Subsection
(4)
.
Section 7. Section
26C-1-101
is enacted to read:
26C. Utah Cares Act
1. General Provisions
26C-1-101
Effective
07/01/27
. Utah Cares Act.
This title is known as the "Utah Cares Act."
Section 8. Section
26C-1-102
is enacted to read:
26C-1-102
Effective
07/01/27
. Definitions.
As used in this title:
(1)
"Accredited clinical education program" means a clinical education program for a health
care profession that is accredited by the Accreditation Council on Graduate Medical
Education.
(2)
"Accredited clinical training program" means a clinical training program that is
accredited by an entity recognized within medical education circles as an accrediting
body for medical education, advanced practice nursing education, physician assistant
education, doctor of pharmacy education, dental education, or registered nursing
education.
(3)
"Centers for Medicare and Medicaid Services" means the Centers for Medicare and
Medicaid Services within the United States Department of Health and Human Services.
(4)
"Commission" means the Utah Health Services Commission created in Section
26C-2-101
.
(5)
"Enrollee" means an individual enrolled in the program.
(6)
"Executive director" means the executive director of the program.
(7)
"Fund" means the Utah Cares Trust Fund, created in Section
26C-1-103
.
(8)
"General acute hospital" means the same as that term is defined in Section
26B-2-201
.
(9)
"Health care facility" means the same as that term is defined in Section
26B-2-201
.
(10)
"Health care professionals in training" means medical students and residents, advanced
practice nursing students, physician assistant students, doctor of pharmacy students,
dental students, and registered nursing students.
(11)
(a)
"Health workforce" means the individuals, collectively and by profession, who
deliver health care services or assist in the delivery of health care services.
(b)
"Health workforce" includes any health care professional who does not work in the
health sector and any non-health care professional who works in the health sector.
(12)
"Medical education program" means the program created in Section
26C-2-108
.
(13)
"Nursing care facility" means the same as that term is defined in Section
26B-2-201
.
(14)
"Operating and capital budget facility" means any of the following:
(a)
a nursing care facility;
(b)
a general acute hospital; and
(c)
a specialty hospital.
(15)
"Pharmacist" means the same as that term is defined in Section
58-17b-102
.
(16)
"Pharmacy" means the same as that term is defined in Section
58-17b-102
.
(17)
"Pharmacy service" means a product, good, or service provided by a pharmacy or
pharmacist to an individual.
(18)
"Physician" means an individual:
(a)
licensed as a physician under Title 58, Chapter 67, Utah Medical Practice Act; or
(b)
licensed as a physician under Title 58, Chapter 68, Utah Osteopathic Medical
Practice Act.
(19)
"Program" means the Utah Cares Health Financing Program.
(20)
"Rural county" means a county of the third, fourth, fifth, or sixth class under Section
17-60-104
.
(21)
"Rural hospital" means a general acute hospital located within a rural county.
(22)
"Specialty hospital" means the same as that term is defined in Section
26B-2-201
.
(23)
"UMEC" means the Utah Medical Education Council created in Section
26C-2-107
.
Section 9. Section
26C-1-103
is enacted to read:
26C-1-103
Effective
07/01/27
. Utah Cares Trust Fund -- Audit.
(1)
There is created the "Utah Cares Trust Fund" for the purpose of paying the benefits and
the costs of administering this program.
(2)
The fund shall consist of:
(a)
money appropriated to the fund by the Legislature;
(b)
money provided under Section
26C-3-101
;
(c)
tax revenue deposited under Title 59, Chapter 35, Utah Health Care Tax;
(d)
money paid by non-enrollees to the program for health care services provided by an
operating and capital budget facility;
(e)
any federal funds received from the federal government for federal savings resulting
from 42 U.S.C. Sec. 18052; and
(f)
the reserve funds of private insurers.
(3)
The fund shall be used to pay for:
(a)
health care provided to enrollees of the program;
(b)
enrollees of Medicaid when all waivers are approved as described in Section
26B-3-104.1
;
(c)
payments to a operating and capital budget facility;
(d)
administering the program; and
(e)
benefits provided under this title.
(4)
Every two years, the Insurance Department shall audit the Utah Cares Trust Fund and
programs authorized under this chapter and report the Insurance Department's findings
to the governor and the Legislature, but the commissioner may accept the annual audited
statement of the programs under this chapter in lieu of the biennial audit requirement.
Section 10. Section
26C-1-104
is enacted to read:
26C-1-104
Effective
07/01/27
. Social security number prohibition.
Notwithstanding the provisions of Subsection
31A-1-103(3)(f)
, the program shall
comply with the provisions of Section
31A-22-634
.
Section 11. Section
26C-2-101
is enacted to read:
2.
Utah Health Service Commission
26C-2-101
Effective
07/01/27
. Utah Health Services Commission -- Creation --
Members -- Terms -- Quorum -- Compensation.
(1)
Notwithstandi
ng
S
ection
63E-1-302
, there is created an independent state agency
known as the Utah Health Services Commission.
(2)
The commission shall consist of seven members appointed by the governor, with the
advice and consent of the Senate and in accordance with Title 63G, Chapter 24, Part 2,
Vacancies.
(3)
(a)
Subject to Subsection
(3)(e)
, the term of office of each appointed commission
member is six years.
(b)
A member may be appointed to more than one term.
(c)
When a vacancy occurs in the membership for any reason, the replacement shall be
appointed for the unexpired term by the governor with advice and consent of the
Senate.
(d)
Any member of the commission may be removed for cause by the governor.
(e)
The terms of the members shall be staggered to ensure that at least two
commissioners are appointed for a term of six years on February 1 of each
odd-numbered year.
(4)
(a)
A majority of the commission members constitutes a quorum.
(b)
The action of a majority of a quorum constitutes the action of the commission.
(c)
One member of the commission shall be designated by the governor as chair of the
commission.
(5)
Commissioners shall receive compensation as established by the governor within the
salary range fixed by the Legislature in Title 67, Chapter 22, State Officer
Compensation, and all actual and necessary expenses incurred in attending to official
business.
(6)
Each commissioner at the time of appointment and qualification shall be a resident
citizen of the United States and of this state.
(7)
Except as provided by law, no commissioner may hold any other office either under the
government of the United States or of this state or of any municipal corporation within
this state.
(8)
A commissioner shall comply with the conflict of interest provisions described in Title
63G, Chapter 24, Part 3, Conflicts of Interest.
Section 12. Section
26C-2-102
is enacted to read:
26C-2-102
Effective
07/01/27
. Commission duties.
The commission shall:
(1)
design and administer the program;
(2)
establish a budget for the program;
(3)
ensure the delivery of quality health care services to all enrollees;
(4)
conduct regular audits and evaluations of the system's performance and
cost-effectiveness;
(5)
provide an annual report to the governor and the Legislature on the status and
performance of the program;
(6)
promote cooperation among providers;
(7)
create advisory boards to address health care needs regarding health care quality
improvement, health care modernization, and financial budgeting;
(8)
create regional advisory boards to solicit information regarding the various health care
needs in the different regions of the state;
(9)
adjudicate disputes between patients, the program, health care providers, and health care
facilities;
(10)
develop a no-fault medical injury payment system as an alternative to litigation;
(11)
establish and conduct public meetings where patients, health care providers, and health
care facilities may provide feedback to the commission; and
(12)
make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking
Act, to implement and administer this chapter.
Section 13. Section
26C-2-103
is enacted to read:
26C-2-103
Effective
07/01/27
. Planning and forecasting health care needs.
(1)
The commission shall:
(a)
coordinate health care resources and capital expenditures to ensure all enrollees have
reasonable access to covered services;
(b)
develop short term and long term plans to meet health care needs;
(c)
complete an annual review of health care needs, including:
(i)
evaluating health care workforce needs;
(ii)
establishing a budget for all operating and capital budget facilities;
(iii)
evaluating all capital expenses in excess of a threshold amount to be determined
annually by the commission; and
(iv)
collaborating with local and statewide government and health care institutions to
coordinate capital health planning and investment;
(d)
develop short term and long term plans to meet capital expenditure needs; and
(e)
develop plans to improve access to care in rural and frontier counties in the state.
(2)
When conducting the review described in Subsection
(1)(c)
, the commission shall:
(a)
consult with:
(i)
advisory boards created by the commission; and
(ii)
the Utah Health Workforce Advisory Council; and
(b)
hold public hearings across the state.
(3)
The commission may request assistance from the program to carry out the duties
described in this section.
Section 14. Section
26C-2-104
is enacted to read:
26C-2-104
Effective
07/01/27
. Health care best practices.
(1)
The commission shall establish a best practices standard of care regarding:
(a)
appropriate hospital staffing levels;
(b)
evidence-based best clinical practices, including for primary care and mental health
care;
(c)
appropriate medical technology;
(d)
design and scope of work in the health workplace;
(e)
development of clinical practices that lead toward the elimination of medical errors
or medical waste;
(f)
timely access to needed medical and dental care; and
(g)
compassionate end-of-life care to provide comfort and relieve pain.
(2)
The commission may request assistance from the program to carry out the duties
described in this section.
Section 15. Section
26C-2-105
, which is renumbered from Section 26B-1-425 is renumbered
and amended to read:
26B-1-425
26C-2-105
Effective
07/01/27
Repealed
07/01/27
. Utah Health
Workforce Advisory Council -- Creation and membership.
(1)
There is created within the
department
commission
the Utah Health Workforce
Advisory Council.
(2)
The council shall be comprised of at least
14
15
but not more than
19
20
members.
(3)
The following are members of the council:
(a)
the executive director
of the Department of Health and Human Services
or that
individual's designee;
(b)
the executive director of the Department of Workforce Services or that individual's
designee;
(c)
the commissioner of higher education of the Utah System of Higher Education or
that individual's designee;
(d)
the state superintendent of the State Board of Education or that individual's designee;
(e)
the executive director of the Department of Commerce or that individual's designee;
(f)
the director of the Division of Multicultural Affairs or that individual's designee;
(g)
the director of the Utah Substance Use and Mental Health Advisory Committee or
that individual's designee;
(h)
the chair of the Utah Indian Health Advisory Board;
and
(i)
the chair of the Utah Medical Education Council created in Section
26B-4-706
.
26C-2-107
; and
(j)
the executive director or that individual's designee.
(4)
The executive director shall appoint at least five but not more than ten additional
members that represent diverse perspectives regarding Utah's health workforce as
defined in Section
26B-4-705
26C-2-106
.
(5)
(a)
A member appointed by the executive director under Subsection
(4)
shall serve a
four-year term.
(b)
Notwithstanding Subsection
(5)(a)
for the initial appointments of members described
in Subsection
(4)
the executive director shall appoint at least three but not more than
five members to a two-year appointment to ensure that approximately half of the
members appointed by the executive director rotate every two years.
(6)
The executive director or the executive director's designee shall chair the council.
(7)
(a)
As used in this Subsection (7), "health workforce" means the same as that term
is defined in Section
26B-4-705
.
(b)
(7)
The council shall:
(i)
(a)
meet at least once each quarter;
(ii)
(b)
study and provide recommendations to an entity described in Subsection
(8)

regarding:
(A)
(i)
health workforce supply;
(B)
(ii)
health workforce employment trends and demand;
(C)
(iii)
options for training and educating the health workforce;
and
(D)
(iv)
the implementation or improvement of strategies that entities in the state are
using or may use to address health workforce needs including shortages,
recruitment, retention, and other Utah health workforce priorities as determined by
the council;
(iii)
(c)
provide guidance to an entity described in Subsection
(8)
regarding health
workforce related matters;
(iv)
(d)
review and comment on legislation relevant to Utah's health workforce; and
(v)
(e)
advise the Utah Board of Higher Education and the Legislature on the status and
needs of the health workforce who are in training.
(8)
The council shall provide information described in Subsections
(7)(b)(ii)
(7)(b)
and
(iii)
(c)
to:
(a)
the Legislature;
(b)
the
department
Department of Health and Human Services
;
(c)
the Department of Workforce Services;
(d)
the Department of Commerce;
(e)
the Utah Medical Education Council; and
(f)
any other entity the council deems appropriate upon the entity's request.
(9)
(a)
The Utah Medical Education Council created in Section
26B-4-706
26C-2-107
is
a subcommittee of the council.
(b)
The council may establish subcommittees to support the work of the council.
(c)
A member of the council shall chair a subcommittee created by the council.
(d)
Except for the Utah Medical Education Council, the chair of the subcommittee may
appoint any individual to the subcommittee.
(10)
For any report created by the council that pertains to any duty described in Subsection
(7)
, the council shall:
(a)
provide the report to:
(i)
the
department
commission
; and
(ii)
any appropriate legislative committee; and
(b)
post the report on the council's website.
(11)
The executive director shall:
(a)
ensure the council has adequate staff to support the council and any subcommittee
created by the council; and
(b)
provide any available information upon the council's request if:
(i)
that information is necessary for the council to fulfill a duty described in
Subsection
(7)
; and
(ii)
the
department
commission
has access to the information.
(12)
A member of the council or a subcommittee created by the council may not receive
compensation or benefits for the member's service but may receive per diem and travel
expenses as allowed in:
(a)
Section
63A-3-106
;
(b)
Section
63A-3-107
; and
(c)
rules made by the Division of Finance according to Sections
63A-3-106
and
63A-3-107
.
Section 16. Section
26C-2-106
, which is renumbered from Section 26B-4-705 is renumbered
and amended to read:
26B-4-705
26C-2-106
Effective
07/01/27
. Utah Health Workforce Information
Center.
(1)
As used in this section:
(a)
"Council" means the Utah Health Workforce Advisory Council created in Section
26B-1-425
26C-2-105
.
(b)
"Health sector" means any place of employment where the primary function is the
delivery of health care services.
(c)
(i)
"Health workforce" means the individuals, collectively and by profession,
who deliver health care services or assist in the delivery of health care services.
(ii)
"Health workforce" includes any health care professional who does not work in
the health sector and any non-health care professional who works in the health
sector.
(2)
There is created within the department the Utah Health Workforce Information Center.
(3)
The information center shall:
(a)
under the guidance of the council, work with the Department of Commerce to collect
data described in Section
58-1-112
;
(b)
analyze data from any available source regarding Utah's health workforce including
data collected by the Department of Commerce under Section
58-1-112
;
(c)
send a report to the council regarding any analysis of health workforce data;
(d)
conduct research on Utah's health workforce as directed by the council;
(e)
notwithstanding the provisions of Subsection
35A-4-312(3)
, receive information
obtained by the Department of Workforce Services under the provisions of Section
35A-4-312
for purposes consistent with the information center's duties, including
identifying changes in Utah's health workforce numbers, types, and geographic
distribution;
(f)
subject to
data sharing limitations the program creates that are the same or
substantially similar to limitations described in
Section
26B-8-406
, share data with
any appropriate person as determined by the information center; and
(g)
conduct research and provide analysis for any state agency as approved by the
executive director or the executive director's designee
commission
.
(4)
Notwithstanding any other provision of state law, the information center is authorized to
obtain data from any state agency if:
(a)
the council and the information center deem receiving the data necessary to perform
a duty listed under Subsection
(3)
or
26B-1-425(7)
26C-2-105(7)
; and
(b)
the information center's access to the data will not:
(i)
violate any federal statute or federal regulation; or
(ii)
violate a condition a state agency must follow:
(A)
to participate in a federal program; or
(B)
to receive federal funds.
Section 17. Section
26C-2-107
, which is renumbered from Section 26B-4-706 is renumbered
and amended to read:
26B-4-706
26C-2-107
Effective
07/01/27
. Utah Medical Education Council.
(1)
(a)
There is created the Utah Medical Education Council, which is a subcommittee of
the Utah Health Workforce Advisory Council.
(b)
The membership of UMEC shall consist of the following appointed by the governor:
(i)
the dean of the school of medicine at the University of Utah;
(ii)
an individual who represents graduate medical education at the University of
Utah;
(iii)
an individual from each institution, other than the University of Utah, that
sponsors an accredited clinical education program;
and
(iv)
an individual from the health care insurance industry; and
(v)
(iv)
(A)
three members of the general public who are not employed by or
affiliated with any institution that offers, sponsors, or finances health care or
medical education; and
(B)
if the number of individuals appointed under Subsection
(1)(b)(iii)
is more
than two, the governor may appoint an additional member of the public under
this Subsection
(1)(b)(v)
(1)(b)(iv)
for each individual the governor appoints
under Subsection
(1)(b)(iii)
beyond two.
(2)
Except as provided in Subsections
(1)(b)(i)
and
(ii)
, no two UMEC members may be
employed by or affiliated with the same:
(a)
institution of higher education;
(b)
state agency outside of higher education; or
(c)
private entity.
(3)
The dean of the school of medicine at the University of Utah:
(a)
shall chair UMEC;
(b)
may not be counted in determining the existence of a quorum; and
(c)
may only cast a vote on a matter before the council if the vote of the other council
members results in a tied vote.
(4)
UMEC shall annually elect a vice chair from UMEC's members.
(5)
(a)
Consistent with Subsection
(6)(b)
, a
A
majority of the members constitute a
quorum.
(b)
The action of a majority of a quorum is the action of UMEC.
(6)
(a)
Except as provided in Subsection
(6)(b)
, members are appointed to four-year
terms of office.
(b)
Notwithstanding Subsection
(6)(a)
, the governor shall, at the time of the initial
appointment, adjust the length of terms to ensure that the terms of UMEC members
are staggered so that approximately half of the members are appointed every two
years.
(c)
If a vacancy occurs in the membership for any reason, the replacement shall be
appointed by the governor for the unexpired term in the same manner as the original
appointment was made.
(7)
A member may not receive compensation or benefits for the member's service, but may
receive per diem and travel expenses in accordance with:
(a)
Section
63A-3-106
;
(b)
Section
63A-3-107
; and
(c)
rules made by the Division of Finance
pursuant to
Sections
63A-3-106
and
63A-3-107
.
(8)
The council shall provide staff for UMEC.
Section 18. Section
26C-2-108
, which is renumbered from Section 26B-4-707 is renumbered
and amended to read:
26B-4-707
26C-2-108
Effective
07/01/27
. Medical education program.
(1)
There is created a
Medical Education Program
medical education program
to be
administered by UMEC in cooperation with the Division of Finance.
(2)
The
program
medical education program
shall be funded from money received for
graduate medical education from:
(a)
the federal Centers for Medicare and Medicaid Services or other federal agency;
(b)
state appropriations; and
(c)
donation or private contributions.
(3)
All funding for this
program
medical education program
shall be nonlapsing.
(4)
Program
Medical education program
money may only be expended if:
(a)
approved by UMEC; and
(b)
used for graduate medical education in accordance with
Subsection
26B-4-708(4)
Section
26C-2-109
.
Section 19. Section
26C-2-109
, which is renumbered from Section 26B-4-708 is renumbered
and amended to read:
26B-4-708
26C-2-109
Effective
07/01/27
. Duties of UMEC.
UMEC shall:
(1)
seek private and public contributions for the
program
medical education program
;
(2)
determine the method for reimbursing institutions that sponsor health care professionals
in training;
(3)
determine the number and type of positions for health care professionals in training for
which
program
medical education program
money may be used;
(4)
distribute
program
medical education program
money for graduate medical education
in a manner that:
(a)
prepares postgraduate medical residents, as defined by the accreditation council on
graduate medical education, for inpatient, outpatient, hospital, community, and
geographically diverse settings;
(b)
encourages the coordination of interdisciplinary clinical training among health care
professionals in training;
(c)
promotes stable funding for the clinical training of health care professionals in
training; and
(d)
only funds accredited clinical training programs; and
(5)
advise on the implementation of the program.
Section 20. Section
26C-2-110
, which is renumbered from Section 26B-4-709 is renumbered
and amended to read:
26B-4-709
26C-2-110
Effective
07/01/27
. Powers of UMEC.
The UMEC may:
(1)
appoint advisory committees of broad representation on interdisciplinary clinical
education, workforce mix planning and projections, funding mechanisms, and other
topics as is necessary;
(2)
use federal money for necessary administrative expenses to carry out UMEC's duties
and powers as permitted by federal law;
(3)
distribute program money in accordance with Subsection
26B-4-708(4)
26C-2-109(4)
;
and
(4)
as is necessary to carry out UMEC's duties under Section
26B-4-708
26C-2-109
,
adopt
rules
in accordance with
Title 63G, Chapter 3, Utah Administrative Rulemaking Act
.
Section 21. Section
26C-2-111
, which is renumbered from Section 26B-4-711 is renumbered
and amended to read:
26B-4-711
26C-2-111
Effective
07/01/27
. Residency grant program.
(1)
As used in this section:
(a)
"D.O. program" means an osteopathic medical program that prepares a graduate to
obtain licensure as a doctor of osteopathic medicine upon completing a state's
licensing requirements.
(b)
"M.D. program" means a medical education program that prepares a graduate to
obtain licensure as a doctor of medicine upon completing a state's licensing
requirements.
(c)
"Residency program" means a program that provides training for graduates of a D.O.
program or an M.D. program.
(2)
UMEC shall develop a grant program where a sponsoring institution in Utah may apply
for a grant to establish a new residency program or expand a current residency program.
(3)
An applicant for a grant shall:
(a)
provide the proposed specialty area for each grant funded residency position;
(b)
identify where the grant funded residency position will provide care;
(c)
(i)
provide proof that the residency program is accredited by the Accreditation
Council for Graduate Medical Education; or
(ii)
identify what actions need to occur for the proposed residency program to
become accredited by the Accreditation Council for Graduate Medical Education;
(d)
identify how a grant funded residency position will be funded once the residency
program exhausts the grant money;
(e)
agree to implement selection processes for a residency position that treat applicants
from D.O. programs and applicants from M.D. programs equally;
(f)
agree to provide information identified by UMEC that relates to post-residency
employment outcomes for individuals who work in grant funded residency positions;
and
(g)
provide any other information related to the grant application UMEC deems
necessary.
(4)
UMEC shall prioritize awarding grants to new or existing residency programs that will:
(a)
address a workforce shortage, occurring in Utah, for a specialty; or
(b)
serve an underserved population, including a rural population.
(5)
(a)
An applicant that receives a grant under this section may apply, every two years,
to renew the grant for two years.
(b)
An applicant to renew a grant under Subsection
(5)(a)
shall provide a statement that:
(i)
the applicant applied for federal funding and was not awarded federal funding in
an amount that fully funds each grant funded residency position; or
(ii)
the funding the applicant described in Subsection
(3)(d)
is unavailable to the
applicant.
(6)
Each November 1 until November 2026 and then every three years thereafter, the
Health Workforce Advisory Council, in consultation with UMEC, shall provide a
written report to the Higher Education Appropriations Subcommittee and the Social
Services Appropriations Subcommittee describing:
(a)
which sponsoring institutions received a grant;
(b)
the number of residency positions created; and
(c)
for each residency position created:
(i)
the type of specialty;
(ii)
where the residency position provides care; and
(iii)
an estimated date of when a grant funded residency position will no longer need
grant funding.
Section 22. Section
26C-2-112
, which is renumbered from Section 26B-4-712 is renumbered
and amended to read:
26B-4-712
26C-2-112
Effective
07/01/27
. Forensic psychiatrist fellowship
grant.
(1)
As used in this section, "forensic psychiatry" means the provision of services by an
individual who:
(a)
is a licensed physician;
(b)
is board certified or board eligible for a psychiatry specialization recognized by the
American Board of Medical Specialists or the American Osteopathic Association's
Bureau of Osteopathic Specialists; and
(c)
uses scientific and clinical expertise in legal contexts involving the mental health of
individuals.
(2)
UMEC shall establish a grant program that will facilitate the creation of a single
forensic psychiatrist fellowship program.
(3)
An applicant for the grant shall:
(a)
demonstrate how the applicant is best suited for developing a forensic psychiatry
fellowship program, including:
(i)
a description of resources that would be available to the program; and
(ii)
any resources or staff that need to be acquired for the program;
(b)
identify what needs to occur for the proposed residency program to become
accredited by the Accreditation Council for Graduate Medical Education;
(c)
provide an estimate of how many individuals would be trained in the program at any
one time;
(d)
provide any information related to the grant application UMEC deems necessary for
awarding the grant; and
(e)
if awarded the grant, agree to:
(i)
enter into a contract with the Department of Corrections that the applicant will
provide for the provision of forensic psychiatry services to an individual:
(A)
who needs psychiatric services; and
(B)
is under the Department of Corrections' jurisdiction; and
(ii)
ensure that any individual hired to provide forensic psychiatry services will
comply with all relevant:
(A)
national licensing requirements; and
(B)
state licensing requirements under Title 58, Occupations and Professions.
Section 23. Section
26C-3-101
is enacted to read:
3. Utah Cares Health Financing Program
26C-3-101
Effective
07/01/27
. Program -- Executive director -- Duties.
(1)
The commission shall appoint an executive director who shall be the executive and
administrative head of the program.
(2)
The executive director:
(a)
may hire and remove employees and consultants as necessary to accomplish the
duties described in this chapter and to assist with the commission's duties;
(b)
shall establish an enrollment system that will ensure that all eligible Utah residents
are formally enrolled;
(c)
shall ensure the program carries out duties assigned to the program under this title;
and
(d)
may utilize and shall coordinate with the offices, staff, and resources of any agencies
of the executive branch.
(3)
The program shall:
(a)
act as a self-insurer of enrollee benefit plans and administer those plans;
(b)
indemnify benefit plans or purchase commercial reinsurance as considered
appropriate by the program;
(c)
process claims by making prompt payments to health care providers and health care
facilities for covered services;
(d)
invest trust fund assets consistent with state law;
(e)
establish and maintain a formulary of covered prescription drugs and negotiate prices
with pharmaceutical companies;
(f)
obtain an annual actuarial review of all health and dental benefit plans and a periodic
review of the program;
(g)
annually submit a budget and audited financial statements to the governor and
Legislature that includes total projected benefit costs and administrative costs;
(h)
submit the program's recommended benefit and rate adjustments to:
(i)
the Legislature;
(ii)
the commission; and
(iii)
the director of the state Division of Human Resource Management;
(i)
administer benefits and rates upon ratification of the commission;
(j)
(i)
require enrollees to participate in the electronic exchange of clinical health
records in accordance with Section
26B-8-411
unless the enrollee opts out of
participation; and
(ii)
before enrollment, each time the enrollee logs onto the program's website, and
each time the enrollee receives written enrollment information from the program,
provide notice to the enrollee of the enrollee's participation in the electronic
exchange of clinical health records and the option to opt out of participation at any
time;
(k)
develop an information management system that is compatible with medical and
dental facilities and offices in the state;
(l)
develop a system to monitor the quality of care;
(m)
develop utilization management strategies;
(n)
be the state's primary entity for applying for and negotiating waivers described in 42
U.S.C. Sec. 18052;
(o)
negotiate with the federal government to provide coverage for veterans, Native
Americans, federal employees, and the military; and
(p)
take additional actions necessary or appropriate to carry out the purposes of this
chapter.
(4)
The program may establish a partnership with a public entity in a different state to
purchase or share services related to the administration of medical benefits if:
(a)
the program receives approval for the partnership from the commission; and
(b)
the partnership:
(i)
creates cost savings for Utah;
(ii)
does not commingle state funds with funds of the public entity in the other state;
and
(iii)
does not pose a greater actuarial risk to Utah than the program has already
assumed.
(5)
Before January 1, 2031, the program shall provide a report to the Legislature regarding
the coordination and incorporation of benefits for medically necessary care between the
program and the following:
(a)
workers' compensation;
(b)
automotive insurance carriers; and
(c)
other entities that provide indemnity insurance that involves medical care.
Section 24. Section
26C-3-102
is enacted to read:
26C-3-102
Effective
01/01/28
. Eligibility.
(1)
An individual is eligible to enroll in the program if the individual is:
(a)
a United States citizen;
(b)
lives in Utah as evidenced by an intent to continue to live in Utah and to return to
Utah if temporarily absent, coupled with an act or acts consistent with that intent; and
(c)
not enrolled in Medicaid or Medicare.
(2)
Beginning January 1, 2028, the program shall enroll:
(a)
employees of:
(i)
the state;
(ii)
counties and municipalities;
(iii)
public school districts;
(iv)
charter schools; and
(v)
state institutions of higher education; and
(b)
individuals described in Section
53-2d-703
.
(3)
Beginning January 1, 2028, and ending on January 1, 2030, entities described in
Subsection
(2)
(a) shall transfer money to the fund equal to the annual amount the entity
expended to provide employee health insurance as of January 1, 2026.
(4)
Beginning January 1, 2029, the program shall begin enrolling any eligible individual.
(5)
Beginning January 1, 2029, a nonprofit entity may choose to merge the nonprofit
entity's health benefit plan with the program if the nonprofit entity transfers funds equal
to the annual amount of funds the nonprofit entity expended to provide employee health
care:
(a)
based on the immediate year before the transfer; and
(b)
for at least two years thereafter.
Section 25. Section
26C-4-101
is enacted to read:
4. Rates and Payments
26C-4-101
Effective
01/01/28
. Payments for non-enrollee health care --
Out-of-state care -- Secondary coverage.
(1)
Beginning November 1, 2029, for health care services provided to a non-enrollee, the
program will bill the individual and reimburse the health care provider at a reasonable
rate.
(2)
(a)
Payment for emergency care of an enrollee obtained out-of-state shall be paid at
prevailing local rates of where the care was obtained.
(b)
Payment for non-emergency care of an enrollee obtained out-of-state shall be
according to rates and conditions established by the commission.
(c)
(i)
The commission may require that an enrollee be transported back to Utah when
prolonged treatment of an emergency condition is necessary if transportation is
safe for the patient in light of the patient's medical condition.
(ii)
The program shall pay for transporting an individual described in Subsection
(2)(c)(i)
.
(3)
If an enrollee has other health insurance coverage for a service that is covered by the
program, the program shall act as the secondary insurer for insurance coverage purposes.
Section 26. Section
26C-4-102
is enacted to read:
26C-4-102
Effective
01/01/28
. Health care provider and facility rates and
payments.
(1)
Beginning November 1, 2029, a health care facility may not bill an individual for
services performed by the health care facility.
(2)
Except for operating and capital budget facilities, the program shall negotiate and set
rates for health care providers and health care facilities participating in the program in an
amount equal to or exceeding the Medicare fee amount plus 10% of the Medicare fee.
(3)
(a)
The program shall negotiate with each operating and capital budget facility
independently to set a specific operating and capital budget for each facility.
(b)
The program shall make payments to an operating and capital budget facility on a
monthly basis.
Section 27. Section
26C-5-101
is enacted to read:
5. Covered Health Benefits
26C-5-101
Effective
01/01/28
. Health plan.
(1)
The program shall provide a health plan that:
(a)
complies with 42 U.S.C. Sec. 18022(b)(1);
(b)
unless otherwise provided in this title, contains no cost-sharing for all
non-pharmaceutical services;
(c)
provides the lowest possible cost-sharing for pharmaceutical services; and
(d)
maintains a benefits offering that is equivalent to the offering provided to state
employees as of January 1, 2026.
(2)
As soon as practicable, the program shall develop a Medicare advantage plan for
eligible individuals.
Section 28. Section
26C-5-102
, which is renumbered from Section 49-20-416 is renumbered
and amended to read:
49-20-416
26C-5-102
Effective
01/01/28
. Screening, Brief Intervention, and
Referral to Treatment program reimbursement.
(1)
As used in this section:
(a)
"Controlled substance prescriber" means a controlled substance prescriber, as that
term is defined in Section
58-37-6.5
, who:
(i)
has a record of having completed SBIRT training, in accordance with Subsection
58-37-6.5(2)
, before providing the SBIRT services; and
(ii)
is a program enrolled controlled substance prescriber.
(b)
"SBIRT" means the same as that term is defined in Section
58-37-6.5
.
(2)
The
health
program
offered to the state employee risk pool under Section
49-20-202

shall reimburse a controlled substance prescriber who provides SBIRT services to
a
covered individual
an enrollee
who is 13 years
of age
old
or older for the SBIRT
services.
Section 29. Section
26C-5-103
, which is renumbered from Section 49-20-418 is renumbered
and amended to read:
49-20-418
26C-5-103
Effective
01/01/28
. Expanded infertility treatment
benefit.
(1)
As used in this section:
(a)
"Assisted reproductive technology" means the same as the term is defined in 42
U.S.C. Sec. 263a-7.
(b)
"Physician" means the same as the term is defined in Section
58-67-102
.
(c)
"Qualified assisted reproductive technology cycle" means the use of covered assisted
reproductive technology to transfer a single embryo for implantation.
(d)
"Qualified individual" means an individual
:
(i)
covered within the state risk pool; and
(ii)

eligible for maternity benefits under the program.
(2)
(a)
The program shall provide coverage for qualified assisted reproductive technology
cycles.
(b)
The benefit is subject to the same cost sharing requirements as the qualified
individual's plan.
(3)
A qualified individual shall receive the benefit described in Subsection
(2)
if:
(a)
the qualified individual is the patient who will use the assisted reproductive
technology;
(b)
(i)
the patient's physician verifies that the patient or the patient's spouse has a
demonstrated condition recognized by a physician as a cause of infertility; or
(ii)
the patient attests that the patient is unable to conceive a pregnancy or carry a
pregnancy to a live birth after a year or more of regular sexual relations without
contraception;
(c)
the patient attests that the patient has been unable to attain a successful pregnancy
through any less-costly, potentially effective infertility treatments for which coverage
is available under the health benefit plan; and
(d)
the use of the assisted reproductive technology procedure complies with the
program's clinical policies and is performed by a health care provider who contracts
with or is otherwise approved by the program.
(4)
(a)
The provision of a benefit in accordance with this section shall satisfy, in
accordance with Subsection
31A-22-610.1(1)(c)(ii)
, the requirement to provide an
adoption indemnity benefit to a qualified individual under Section
31A-22-610.1
.
(b)
If a qualified individual has received the adoption indemnity benefit required under
Section
31A-22-610.1
, the qualified individual may not receive a benefit in
accordance with this section.
Section 30. Section
26C-5-104
, which is renumbered from Section 49-20-419 is renumbered
and amended to read:
49-20-419
26C-5-104
Effective
01/01/28
. Coverage of exome sequence testing.
(1)
As used in this section, "exome sequence testing" means a genomic technique for
sequencing the genome of an individual for diagnostic purposes.
(2)
Beginning July 1, 2019, the
The
program shall provide coverage for exome sequence
testing:
(a)
for
a covered individual within the state risk pool
an enrollee
who:
(i)
is younger than 21 years
of age
old
; and
(ii)
who remains undiagnosed after exhausting all other appropriate diagnostic-related
tests;
(b)
performed by a nationally recognized provider with significant experience in exome
sequence testing;
(c)
that is medically necessary; and
(d)
at a rate set by the program.
Section 31. Section
26C-5-105
, which is renumbered from Section 49-20-420 is renumbered
and amended to read:
49-20-420
26C-5-105
Effective
01/01/28
Partially Repealed
01/01/30
.
Coverage for in vitro fertilization and genetic testing.
(1)
As used in this section:
(a)
"Qualified condition" means:
(i)
cystic fibrosis;
(ii)
spinal muscular atrophy;
(iii)
Morquio Syndrome;
(iv)
myotonic dystrophy; or
(v)
sickle cell anemia.
(b)
"Qualified individual" means
a covered individual
an enrollee
who:
(i)
has been diagnosed by a physician as having a genetic trait associated with a
qualified condition; and
(ii)
intends to get pregnant with a partner who is diagnosed by a physician as having
a genetic trait associated with the same qualified condition as the
covered
individual
enrollee
.
(2)
For a plan year that begins on or after July 1, 2020, the
The
program shall provide
coverage for a qualified individual for:
(a)
in vitro fertilization services; and
(b)
genetic testing of a qualified individual who receives in vitro fertilization services
under Subsection
(2)(a)
.
(3)
Before November 1, 2022, and before November 1 of every third year thereafter, the
program shall:
(a)
calculate the change in state spending attributable to the coverage under this section;
and
(b)
report the amount described in Subsection
(3)(a)
to the Health and Human Services
Interim Committee and the Social Services Appropriations Subcommittee.
Section 32. Section
26C-5-106
, which is renumbered from Section 49-20-422 is renumbered
and amended to read:
49-20-422
26C-5-106
Effective
01/01/28
Repealed
07/01/27
. Coverage of
pregnancy and childbirth services, including doula, direct-entry midwife, and birthing
center services.
(1)
As used in this section:
(a)
"Doula" means an individual who:
(i)
provides information and physical and emotional support:
(A)
to a pregnant or postpartum individual; and
(B)
related to the pregnant or postpartum individual's pregnancy; and
(ii)
is certified by one or more organizations approved by the program.
(b)
"Pregnancy and childbirth services" means services provided to a pregnant individual
before, during, or shortly after childbirth:
(i)
by a doula for the services described in Subsections
(1)(a)(i)
and
(ii)
; and
(ii)
at a birthing center that:
(A)
is licensed under
Title 26B, Chapter 2, Licensing and Certifications
, or
accredited by the Commission for the Accreditation of Birth Centers; and
(B)
may include services by a direct-entry midwife licensed under
Title 58,
Chapter 77, Direct-Entry Midwife Act
, if the direct-entry midwife is engaged
in the practice of direct-entry midwifery, as defined in Section
58-77-102
.
(c)
"Qualified individual" means
a covered individual
an enrollee
who
is
:
(i)
within the state employees' risk pool; and
(ii)
(A)
(i)
is pregnant; or
(B)
(ii)
was pregnant within the past six months.
(2)
For a plan year that begins on or after July 1, 2023, and before July 1, 2026, the
program shall cover pregnancy and childbirth services to a qualified individual.
(3)
The program may establish limits for coverage under Subsection
(2)
, including limits
based on:
(a)
the type or number of services provided;
(b)
a qualified individual's physical or emotional condition; and
(c)
conditions for provider participation.
(4)
The program shall report to the Health and Human Services Interim Committee on or
before October 1 of each year regarding coverage provided under Subsection
(2)
,
including:
(a)
covered providers;
(b)
covered services;
(c)
provider payment rates;
(d)
covered-individual cost sharing;
(e)
total provider payments and covered-individual cost sharing; and
(f)
any indicators of whether pregnancy and childbirth services covered under
Subsection
(2)
have:
(i)
reduced pregnancy or postpartum coverage costs; or
(ii)
improved pregnancy or postpartum care.
Section 33. Section
26C-6-101
is enacted to read:
6. Medicaid Division
26C-6-101
Effective
01/01/28
. Reserved.
Reserved.
Section 34. Section
26C-6-102
is enacted to read:
26C-6-102
Effective
01/01/28
. Medicaid Division.
(1)
There is created within the program the Medicaid Division.
(2)
The state Medicaid director shall be the head of the division and report to the executive
director of the program.
(3)
The Medicaid Division shall administer the Medicaid program described in Title 26B,
Health and Human Services Code.
(4)
This section does not take affect until necessary waivers and state plan amendments are
approved under Section
26B-3-104.1
.
Section 35. Section
26C-7-101
, which is renumbered from Section 49-20-406 is renumbered
and amended to read:
7. Employee Benefits
49-20-406
26C-7-101
Effective
01/01/28
. Insurance benefits for employees'
beneficiaries.
(1)
As used in this section:
(a)
"Children" includes stepchildren and legally adopted children.
(b)
"Covered individual" means an employee of the state.
(b)
(c)
(i)
"Line-of-duty death" means a death resulting from:
(A)
external force or violence occasioned by an act of duty as an employee; or
(B)
strenuous activity, including a heart attack or stroke, that occurs during
strenuous training or another strenuous activity required as an act of duty as an
employee.
(ii)
"Line-of-duty death" does not include a death that:
(A)
occurs during an activity that is required as an act of duty as an employee if
the activity is not a strenuous activity, including an activity that is clerical,
administrative, or of a nonmanual nature contributes to the employee's death;
(B)
occurs during the commission of a crime committed by the employee;
(C)
the employee's intoxication or use of alcohol or drugs, whether prescribed or
nonprescribed, contributes to the employee's death; or
(D)
occurs in a manner other than as described in Subsection
(1)(b)(i)
(1)(c)(i)
.
(c)
(d)
(i)
"Strenuous activity" means engagement involving a difficult, stressful, or
vigorous fire suppression, rescue, hazardous material response, emergency
medical service, physical law enforcement, prison security, disaster relief, or other
emergency response activity.
(ii)
"Strenuous activity" includes participating in a participating employer sanctioned
and funded training exercise that involves difficult, stressful, or vigorous physical
activity.
(2)
The beneficiary of a covered individual
who is employed by the state
and who has a
line-of-duty death shall receive
:
(a)

the proceeds of a $50,000 group term life insurance policy paid for by the state and
administered and provided as part of the group life insurance program under this
chapter
; and
.
(b)
group health, dental, and vision coverage paid for by the state that covers the
covered individual's:
(i)
surviving spouse until becoming eligible for Medicare as long as the surviving
spouse continues coverage with the program; and
(ii)
unmarried children up to the age of 26.
(3)
A covered employer not required to provide the benefits under Subsection
(2)
may
provide any of the benefits described in Subsection
(2)
by paying rates established by
the program.
(4)
The benefit provided under Subsection
(2)(a)
(2)
is subject to the same terms and
conditions as the group life insurance program provided under this chapter.
Section 36. Section
31A-22-605.5
is amended to read:
31A-22-605.5
Effective
01/01/28
. Application.
(1)
For purposes of this section "insurance mandate":
(a)
means a mandatory obligation with respect to coverage, benefits, or the number or
types of providers imposed on policies of accident and health insurance; and
(b)
does not mean:
(i)
an administrative rule imposing a mandatory obligation with respect to coverage,
benefits, or providers unless that mandatory obligation was specifically imposed
on policies of accident and health insurance by statute; or
(ii)
an insurance mandate in an essential health benefits package imposed
pursuant to

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
federal rules related to their implementation.
(2)
(a)
Notwithstanding the provisions of Subsection
31A-1-103(3)(f)
, the following shall
apply to health coverage offered
to the state employees' risk pool under Subsection
49-20-202(1)(a)
through the program described in Section
26C-3-101
:
(i)
any law enacted under this title that becomes effective after January 1, 2002,
which provides for an insurance mandate for policies of accident and health
insurance; and
(ii)
in accordance with Section
31A-22-613.5
, disclosure requirements for coverage
limitations.
(b)
Notwithstanding the provisions of Subsection
31A-1-103(3)(f)
, a health insurance
mandate enacted under this title after January 1, 2012, shall apply to
:
the program
described in Section
26C-3-101
.
(i)
health coverage offered to the state employees' risk pool under Subsection
49-20-202(1)(a)
; and
(ii)
health coverage offered to public school districts, charter schools, and
institutions of higher education under Subsection
49-20-201(1)(b)
.
(c)
(3)
If health coverage offered to the state employees' risk pool under Subsections
49-20-201(1)(b)
and
49-20-202(1)(a)
offers coverage in the same manner and to the
same extent as the coverage required by an insurance mandate enacted under this title or
coverage that is greater than the insurance mandate enacted under this title, the coverage
offered to state employees under Subsections
49-20-201(1)(b)
and
49-20-202(1)(a)
will
be considered in compliance with the insurance mandate.
Beginning January 1, 2028, a
political subdivision, a public school district, a charter school, and a state funded
institution of higher education may provide a health benefit plan exclusively through the
program described in Section
26C-3-101
.
(d)
The programs regulated under Subsections
49-20-201(1)(b)
and
49-20-202(1)(a)

shall report to the Retirement and Independent Entities Committee created under
Section
63E-1-201
by November 30 of each year in which a mandate is enacted
under the provisions of this section. The report shall include the costs and benefits of
the particular mandatory obligation.
(3)
(a)
An insurance mandate for policies of accident and health insurance enacted
under this title after January 1, 2012, shall apply to a health plan offered by a public
school district, a charter school, or a state funded institution of higher education that
is not insured through the Public Employees' Benefit and Insurance Program.
(b)
If an insurance mandate for policies of accident and health insurance is enacted
under this title after January 1, 2012, the state shall determine whether each entity
described in Subsections
(2)
and
(3)(a)
offers coverage in the same manner and to the
same extent, or greater than the insurance coverage required in the mandate enacted
after January 1, 2012.
(c)
Before enacting an insurance mandate, the state shall, for each entity that does not
offer coverage in accordance with Subsection
(3)(b)
:
(i)
determine the cost to the entity of implementing the insurance mandate; and
(ii)
appropriate money necessary to fund the full cost to the entity of implementing
the insurance mandate.
Section 37. Section
31A-22-613.5
is amended to read:
31A-22-613.5
Effective
01/01/28
. Price and value comparisons of health
insurance.
(1)
(a)
This section applies to all health benefit plans.
(b)
Subsection
(2)
applies to
:
(i)

all health benefit plans
; and
.
(ii)
coverage offered to state employees under Subsection
49-20-202(1)(a)
.
(2)
The commissioner shall promote informed consumer behavior and responsible health
benefit plans by requiring an insurer issuing a health benefit plan to provide to all
enrollees, before enrollment in the health benefit plan, written disclosure of:
(a)
restrictions or limitations on prescription drugs and biologics, including:
(i)
the use of a formulary;
(ii)
co-payments and deductibles for prescription drugs; and
(iii)
requirements for generic substitution;
(b)
coverage limits under the plan;
(c)
any limitation or exclusion of coverage, including:
(i)
a limitation or exclusion for a secondary medical condition related to a limitation
or exclusion from coverage; and
(ii)
easily understood examples of a limitation or exclusion of coverage for a
secondary medical condition;
(d)
(i)
(A)
each drug, device, and covered service that is subject to a
preauthorization requirement as defined in Section
31A-22-650
; or
(B)
if listing each device or covered service in accordance with Subsection
(2)(d)(i)(A)
is too numerous to list separately, all devices or covered services in
a particular category where all devices or covered services have the same
preauthorization requirement;
(ii)
each requirement for authorization as defined in Section
31A-22-650
for:
(A)
each drug, device, or covered service described in Subsection
(2)(d)(i)(A)
; and
(B)
each category of devices or covered services described in Subsection
(2)(d)(i)(B)
; and
(iii)
sufficient information to allow a network provider or enrollee to submit all of the
information to the insurer necessary to meet each requirement for authorization
described in Subsection
(2)(d)(ii)
;
(e)
whether the insurer permits an exchange of the adoption indemnity benefit in Section
31A-22-610.1
for infertility treatments, in accordance with Subsection
31A-22-610.1(1)(c)(ii)
and the terms associated with the exchange of benefits; and
(f)
whether the insurer provides coverage for telehealth services in accordance with
Section
26B-3-123
and terms associated with that coverage.
(3)
An insurer shall provide the disclosure required by Subsection
(2)
in writing to the
commissioner:
(a)
upon commencement of operations in the state; and
(b)
anytime the insurer amends any of the following described in Subsection
(2)
:
(i)
treatment policies;
(ii)
practice standards;
(iii)
restrictions;
(iv)
coverage limits of the insurer's health benefit plan or health insurance policy; or
(v)
limitations or exclusions of coverage including a limitation or exclusion for a
secondary medical condition related to a limitation or exclusion of the insurer's
health insurance plan.
(4)
(a)
An insurer shall provide the enrollee with notice of an increase in costs for
prescription drug coverage due to a change in benefit design under Subsection
(2)(a)
:
(i)
either:
(A)
in writing; or
(B)
on the insurer's website; and
(ii)
at least 30 days
prior to
the date of the implementation of the increase in cost, or
as soon as reasonably possible.
(b)
If under Subsection
(2)(a)
a formulary is used, the insurer shall make available to
prospective enrollees and maintain evidence of the fact of the disclosure of:
(i)
the drugs included;
(ii)
the patented drugs not included;
(iii)
any conditions that exist as a precedent to coverage; and
(iv)
any exclusion from coverage for secondary medical conditions that may result
from the use of an excluded drug.
(c)
The commissioner shall develop examples of limitations or exclusions of a secondary
medical condition that an insurer may use under Subsection
(2)(c)
.
(5)
Examples of a limitation or exclusion of coverage provided under this section or
otherwise are for illustrative purposes only, and the failure of a particular fact situation
to fall within the description of an example does not, by itself, support a finding of
coverage.
(6)
An insurer shall:
(a)
post the information described in Subsection
(2)(d)
on the insurer's website and
provider portal;
(b)
if requested by an enrollee, provide the enrollee with the information required by this
section by mail or email; and
(c)
if requested by a network provider for a specific drug, device, or covered service,
provide the network provider with the information described in Subsection
(2)(d)
for
the drug, device, or covered service by mail or email.
Section 38. Section
31A-22-635
is amended to read:
31A-22-635
Effective
01/01/28
. Uniform application -- Uniform waiver of
coverage.
(1)
For purposes of this section, "insurer"
:
means the same as that term
(a)

is defined in Subsection
31A-22-634(1)
; and
.
(b)
includes the state employee's risk pool under Section
49-20-202
.
(2)
(a)
Insurers offering a health benefit plan to an individual or small employer shall use
a uniform application form.
(b)
The uniform application form:
(i)
may not include questions about an applicant's health history; and
(ii)
shall be shortened and simplified in accordance with rules adopted by the
commissioner.
(c)
Insurers offering a health benefit plan to a small employer shall use a uniform waiver
of coverage form, which may not include health status related questions, and is
limited to:
(i)
information that identifies the employee;
(ii)
proof of the employee's insurance coverage; and
(iii)
a statement that the employee declines coverage with a particular employer
group.
(3)
Notwithstanding the requirements of Subsection
(2)(a)
, the uniform application and
uniform waiver of coverage forms may, if the combination or modification is approved
by the commissioner, be combined or modified to facilitate a more efficient and
consumer friendly experience for insurers using electronic applications.
(4)
(a)
The uniform application form, and uniform waiver form, shall be adopted and
approved by the commissioner in accordance with
Title 63G, Chapter 3, Utah
Administrative Rulemaking Act
.
(b)
The commissioner shall regulate the fees charged by insurers to an enrollee for a
uniform application form or electronic submission of the application forms.
Section 39. Section
31A-22-647
is amended to read:
31A-22-647
Effective
01/01/28
. Insurer shared savings program.
(1)
As used in this section:
(a)
"Insurer" means a person who offers health care insurance, including a health
maintenance organization as that term is defined in Section
31A-8-101
.
(b)
"PEHP" means the Public Employees' Benefit and Insurance Program created in
Section
49-20-103
.
(c)
(b)
"Savings reward program" means a program to reward a health insurance
enrollee if the enrollee receives services:
(i)
covered by the enrollee's health plan; and
(ii)
from a provider whose costs for services are lower than the average costs for the
services.
(2)
An insurer may, in accordance with Subsection
(4)
(3)
, establish a savings reward
program for a health benefit plan that is:
(a)
offered by the insurer; and
(b)
entered into or renewed on or after January 1, 2019.
(3)
PEHP shall, in accordance with Subsection
(4)
, establish a savings reward program for
a health plan that is:
(a)
offered to state employees under
Title 49, Chapter 20, Public Employees' Benefit
and Insurance Program Act
; and
(b)
entered into or renewed on or after July 1, 2019.
(4)
(3)
A savings reward program described in Subsection
(2)
or
(3)
may include, in
accordance with federal and state law, rewards to the enrollee through:
(a)
premium discounts;
(b)
rebates;
(c)
reduction of out-of-pocket costs; or
(d)
other rewards or incentives developed by the insurer.
Section 40. Section
31A-22-654
is amended to read:
31A-22-654
Effective
01/01/28
. Study of coverage for in vitro fertilization and
genetic testing -- Reporting -- Coverage requirements.
(1)
As used in this section:
(a)
"Qualified condition" means the same as that term is defined in Section
49-20-420
26C-5-105
.
(b)
"Qualified insurer" means an insurer that provides a health benefit plan as defined in
Section
31A-1-301
to more than 25,000 enrollees in the state as of December 31 of
the
preceding
reporting year.
(c)
"Qualified enrollee" means an enrollee of a qualified insurer who:
(i)
has been diagnosed by a physician as having a genetic trait associated with a
qualified condition; and
(ii)
intends to get pregnant with a partner who is diagnosed by a physician as having
a genetic trait associated with the same qualified condition as the enrollee.
(2)
(a)
A qualified insurer shall submit the information described in this Subsection
(2)
to
the department for a plan year beginning:
(i)
on or after January 1, 2022, but before December 31, 2022; and
(ii)
on or after January 1, 2025, but before December 31, 2025.
(b)
A qualified insurer shall study whether providing the coverage for the services
described in Subsections
(3)(a)
and
(b)
for qualified enrollees will result in cost
savings for the qualified insurer.
(c)
(i)
If a qualified insurer determines that providing the coverage described in
Subsection
(3)
for qualified enrollees will result in cost savings for the qualified
insurer, the qualified insurer shall submit a summary of the results of the study
described in Subsection
(2)(b)
, and:
(A)
describe how the qualified insurer intends to provide the coverage described
in Subsection
(3)
; or
(B)
submit an explanation of why the insurer will not provide the coverage
described in Subsection
(3)
.
(ii)
If a qualified insurer determines that providing the coverage described in
Subsection
(3)
will not result in cost savings to the qualified insurer, the qualified
insurer shall submit a summary of the results of the study described in Subsection
(2)(b)
.
(d)
A qualified insurer shall provide the information required under this Subsection
(2)

to the department no later than:
(i)
January 1, 2022, for a plan year beginning on or after January 1, 2022, but before
December 31, 2022; and
(ii)
January 1, 2025, for a plan year beginning on or after January 1, 2025, but before
December 31, 2025.
(3)
A qualified insurer shall consider coverage for:
(a)
in vitro fertilization services for a qualified enrollee; and
(b)
genetic testing of a qualified enrollee who received in vitro fertilization services
under Subsection
(3)(a)
.
(4)
The department shall report the information received under Subsection
(2)
to the Health
and Human Services Interim Committee on or before:
(a)
for information submitted under Subsection
(2)(a)(i)
, November 1, 2022; and
(b)
for information submitted under Subsection
(2)(a)(ii)
, November 1, 2025.
Section 41. Section
31A-22-663
is enacted to read:
31A-22-663
Effective
01/01/28
. Premium prohibition.
(1)
As used in this section, "program" means the Utah Cares Health Financing Program
created Title 26C, Utah Cares Act.
(2)
Notwithstanding any other provision of law, beginning January 1, 2029, a health benefit
plan may not charge premiums for services covered by the program to an individual who
is eligible to receive health benefit coverage through the program.
(3)
If an insurer offering a health benefit plan leaves the Utah market, the insurer shall
forfeit any cash reserves held by the insurer to the department for the provision of health
benefit coverage of individuals in the state.
(4)
The department shall deposit money obtained under this section into the fund described
in Section
26C-1-103
.
Section 42. Section
31A-46-311
is amended to read:
31A-46-311
Effective
01/01/28
. Prohibited actions with respect to the 340B
drug discount program.
(1)
As used in this section,

"manufacturer" means a pharmaceutical manufacturer, including
an agent or affiliate of a pharmaceutical manufacturer.
(2)
A manufacturer may not:
(a)
directly or indirectly restrict or prohibit:
(i)
a pharmacy from contracting with a 340B entity, including by denying the
pharmacy access to a drug that is manufactured by the manufacturer;
(ii)
a 340B entity from contracting with a pharmacy, including by denying the 340B
entity access to a drug that is manufactured by the manufacturer;
(iii)
the acquisition, dispensing, or delivery of a 340B drug to any location authorized
by a 340B entity to receive the drug, unless prohibited by federal law; or
(iv)
a 340B entity from receiving 340B drug discount program pricing for a 340B
drug, including by imposing a time limitation on a 340B entity to replenish or
submit a claim for a 340B drug;
(b)
directly or indirectly:
(i)
require a 340B entity to purchase a 340B drug from a supplier if the manufacturer
would otherwise permit the 340B entity to purchase a drug that is not a 340B drug
from the supplier; or
(ii)
require a 340B entity to submit any claim data, utilization data, or information
about a 340B entity's contracts with a third-party as a condition for allowing the
acquisition of a 340B drug by, or delivery of a 340B drug to, a 340B entity, unless
the data or information sharing is required by federal law; or
(c)
interfere with:
(i)
a contract between a pharmacy and a 340B entity; or
(ii)
the ability of a pharmacy and a 340B entity to enter into a contract.
(3)
The Public Employees' Benefit and Insurance Program created in Section
49-20-103

may adjust the program's business practices to mitigate any financial impacts resulting
from this section.
(4)
(3)
Nothing in this section is to be construed to conflict with federal law.
Section 43. Section
49-21-105
is amended to read:
49-21-105
Effective
01/01/28
. Purpose -- Flexibility -- Administration.
(1)
The purpose of this chapter is to provide long-term disability benefits for an eligible
employee.
(2)
Subject to the provisions of Section
49-21-201
, the program may include one or more
long-term disability benefit plans that differ from the benefit plan specified by this
chapter for
an eligible employee of a covered employer as defined under Section
49-20-102
employers who provided health benefits through the Public Employees'
Benefit and Insurance Program as of January 1, 2027
.
(3)
The program shall be administered by the office, under policies and rules adopted by the
board.
Section 44. Section
53-2d-703
is amended to read:
53-2d-703
Effective
01/01/28
. Volunteer Emergency Medical Service Personnel
Insurance Program -- Creation -- Administration -- Eligibility -- Benefits -- Rulemaking
-- Advisory board.
(1)
As used in this section:
(a)
"Basic life insurance benefit" means the standard group life insurance benefit offered
by PEHP that combines basic life, line-of-duty, accidental death and disability, and
dependent coverage into one benefit package.
(b)
"Basic long-term disability benefit" means a $1,000 monthly benefit arising from a
disability determined in accordance with Title 49, Chapter 21, Public Employees'
Long-Term Disability Act, and excluding any coverage offered on a pilot basis.
(c)
"Dental plan" means the same as that term is defined in Section
31A-22-646
.
(d)
"Health benefit plan" means the same as that term is defined in Section
31A-1-301
.
(e)
"Local government entity" means a political subdivision that:
(i)
is licensed as a ground ambulance provider under Part 5, Ambulance and
Paramedic Providers or a quick response provider as designated under
53-2d-403
;
and
(ii)
does not offer health insurance benefits to volunteer emergency medical service
personnel.
(f)
"PEHP" means the Public Employees' Benefit and Insurance Program created in
Section
49-20-103
.
(g)
"Political subdivision" means a county, a municipality, a limited purpose government
entity described in Title 17B, Limited Purpose Local Government Entities - Special
Districts, or Title 17D, Limited Purpose Local Government Entities - Other Entities,
or an entity created by an interlocal agreement under Title 11, Chapter 13, Interlocal
Cooperation Act.
(h)
"Qualifying association" means an association that represents two or more political
subdivisions in the state.
(i)
"Qualifying community" means any of the following located in a county of the
second class:
(i)
a city of the fifth class; or
(ii)
a town.
(2)
The Volunteer Emergency Medical Service Personnel Insurance Program shall promote
recruitment and retention of volunteer emergency medical service personnel by making
insurance available to volunteer emergency medical service personnel in accordance
with this section.
(3)
(a)
The bureau shall contract with a qualifying association to create, implement, and
administer the Volunteer Emergency Medical Service Personnel Insurance Program
described in this section.
(b)
The qualifying association will create promotional campaigns for the Volunteer
Emergency Medical Service Personnel Insurance Program and volunteer emergency
medical service recruitment and retention including outreach to local government
entities through social media, video production, and other media platforms.
(4)
Participation in the program is limited to any individual who:
(a)
is licensed under Section
53-2d-402
as an emergency medical technician, an
advanced emergency medical technician, or a paramedic;
(b)
is able to perform all necessary functions associated with the license;
(c)
provides emergency medical services under the direction of a local governmental
entity:
(i)
by responding to 20% of calls for emergency medical services in a rolling
twelve-month period; and
(ii)
within a qualifying community or a county of the third, fourth, fifth, or sixth class
by responding to the number of calls described in Subsection
(4)(c)(i)
; and
(iii)
(A)
as a volunteer under the Fair Labor Standards Act, in accordance with 29
C.F.R. Sec. 553.106; or
(B)
as a part-time unbenefited employee, as classified by the employing local
government entity;
(d)
if seeking health insurance:
(i)
(A)
is not eligible for a health benefit plan through an employer or a spouse's
employer; and
(B)
is not eligible for medical coverage under a government sponsored healthcare
program; or
(ii)
the individual's premium cost for individual, double, or family coverage through
another source exceeds 20% or greater of the premium cost of the program created
by this section;
(e)
if seeking dental insurance:
(i)
(A)
is not eligible for a dental plan through an employer or a spouse's employer;
and
(B)
is not eligible for dental coverage under a government sponsored healthcare
program; or
(ii)
the individual's premium cost for individual, double, or family coverage exceeds
20% or greater of the premium cost of the program created by this section; and
(f)
resides in the state.
(5)
(a)
A participant in the program is eligible to participate in PEHP in accordance with
Subsection
(5)(b)
and Subsection
49-20-201(3)
.
(b)
Health and dental benefits available to program participants under PEHP are limited
to health insurance and dental insurance that:
(i)
covers the program participant and the program participant's eligible dependents
on a July 1 plan year;
(ii)
accepts enrollment during an open enrollment period or for a special enrollment
event, including the initial eligibility of a program participant;
(iii)
if the program participant is no longer eligible for benefits, terminates on the last
day of the last month for which the individual is a participant in the Volunteer
Emergency Medical Service Personnel Insurance Program; and
(iv)
is not subject to continuation rights under state or federal law.
(c)
Within existing appropriations, the Volunteer Emergency Medical Service Personnel
Insurance Program may offer basic life insurance and long-term disability insurance
to participants to enhance recruitment and retention efforts.
(6)
(a)
The bureau may make rules in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, to define additional criteria regarding benefit
design, eligibility for the program, and to implement this section.
(b)
The bureau shall convene an advisory board:
(i)
to advise the bureau on making rules under Subsection
(6)(a)
; and
(ii)
that includes representation from at least the following entities:
(A)
the qualifying association that receives the contract under Subsection
(3)
; and
(B)
PEHP.
(7)
For purposes of this section, the qualifying association that receives the contract under
Subsection
(3)
shall be considered the public agency for whom the program participant
is volunteering under 29 C.F.R. Sec. 553.101.
(8)
Notwithstanding any other provision of law, coverage provided under this section shall
be provided under Title 26C, Utah Cares Ac
t
,
be
ginning January 1, 2028.
Section 45. Section
53-17-201
is amended to read:
53-17-201
Effective
01/01/28
. Surviving spouse and children health, dental, and
vision coverage for line-of-duty death.
(1)
(a)
Subject to Subsection
(1)(b)
, and in accordance with this section, an employer
shall allow the surviving spouse and children of a member whose death is classified
by the Utah State Retirement Office as a line-of-duty death under the provisions of
Title 49, Utah State Retirement and Insurance Benefit Act
, to remain eligible for the
following coverage, if offered by the employer, as if the surviving spouse was an
employee of the employer:
(i)
health coverage;
(ii)
dental coverage; and
(iii)
vision coverage.
(b)
Except as provided in Subsection
(1)(d)
, the employer shall pay:
(i)
100% of the premium costs for the coverage described in Subsection
(1)(a)
; and
(ii)
if the health coverage is a high-deductible plan, the employer share of any
contribution into a health savings account for the surviving spouse and dependent
children as described under Subsections
(1)(a)
and
(2)
.
(c)
The employer may not require the surviving spouse to pay for premium costs or
health savings account contributions as a condition of qualifying to continue to
receive the coverage described in Subsection
(1)(a)
.
(d)
An employer may pay the amount specified under Subsection
(1)(b)
through a
cost-sharing agreement under Section
53-17-301
associated with the trust fund
created under Section
53-17-401
.
(2)
An employer shall allow a surviving spouse and children to remain eligible to receive
coverage from the employer under this section at the option of the surviving spouse:
(a)
for the surviving spouse, until the surviving spouse becomes eligible for Medicare;
and
(b)
for a child, until the child reaches the age of 26.
(3)
This section does not apply to:
(a)
a member who does not qualify for a line-of-duty death benefit under
Title 49, Utah
State Retirement and Insurance Benefit Act
;
(b)
coverage for which, at the time of death, the member did not receive or qualify to
receive; or
(c)
a member who is covered under Section
49-20-406
.
(c)
an individual eligible for coverage under Title 26C, Utah Cares Act.
Section 46. Section
58-1-112
is amended to read:
58-1-112
Effective
01/01/28
. Data collection.
(1)
As used in this section:
(a)
"Council" means the Utah Health Workforce Advisory Council created in Section
26B-1-425
26C-2-105
.
(b)
"Information center" means the Utah Health Workforce Information Center created
in Section
26B-4-705
26C-2-106
.
(2)
(a)
In accordance with Subsection
26B-4-705(3)(a)
26C-2-106(3)(a)
, the department
shall work with the information center to identify relevant data pertaining to a
profession described in Subsection
(3)
.
(b)
The data should focus on:
(i)
identifying workforce shortages;
(ii)
identifying labor market indicators;
(iii)
determining the educational background of a licensee; and
(iv)
determining whether Utah is retaining a stable health workforce.
(c)
After the council approves data to be collected, the department shall request the data
from a licensee when a licensee applies for a license or renews the licensee's license.
(d)
The department shall send the obtained data to the information center.
(e)
A licensee may not be denied a license for failing to provide the data described in
Subsection
(2)(c)
to the department.
(3)
(a)
The department shall prioritize data collection for each profession licensed under:
(i)
Chapter 31b, Nurse Practice Act
;
(ii)
Chapter 60, Mental Health Professional Practice Act
;
(iii)
Chapter 61, Psychologist Licensing Act
;
(iv)
Chapter 67, Utah Medical Practice Act
;
(v)
Chapter 68, Utah Osteopathic Medical Practice Act
;
(vi)
Chapter 69, Dentist and Dental Hygienist Practice Act
; or
(vii)
Chapter 70a, Utah Physician Assistant Act
.
(b)
After the department has collected data for each profession described in Subsection
(3)(a)
, the department shall collect data for each profession licensed under:
(i)
Chapter 5a, Podiatric Physician Licensing Act
;
(ii)
Chapter 17b, Pharmacy Practice Act
;
(iii)
Chapter 24b, Physical Therapy Practice Act
;
(iv)
Chapter 40, Recreational Therapy Practice Act
;
(v)
Chapter 41, Speech-Language Pathology and Audiology Licensing Act
;
(vi)
Chapter 42a, Occupational Therapy Practice Act
;
(vii)
Chapter 44a, Nurse Midwife Practice Act
;
(viii)
Chapter 54, Radiologic Technologist, Radiologist Assistant, and Radiology
Practical Technician Licensing Act
; or
(ix)
Chapter 57, Respiratory Care Practices Act
.
(c)
The department shall collect data in accordance with this section for any
health-related occupation or profession that is regulated by the department and is not
described in Subsection
(3)(a)
or
(b)
if:
(i)
funding is available;
(ii)
the council has identified a need for the data; and
(iii)
data has been collected for each profession described in Subsections
(3)(a)
and
(3)(b)
.
Section 47. Section
58-17b-802
is amended to read:
58-17b-802
Effective
01/01/28
. Definitions.
As used in this part:
(1)
(a)
"Cosmetic drug" means a prescription drug that:
(i)
is for the purpose of promoting attractiveness or altering the appearance of an
individual; and
(ii)
(A)
is listed as a cosmetic drug subject to the exemption under this section by
the division by administrative rule; or
(B)
has been expressly approved for online dispensing,
whether or not
it is
dispensed online or through a physician's office.
(b)
"Cosmetic drug" does not include a prescription drug that is:
(i)
a controlled substance;
(ii)
compounded by the physician; or
(iii)
prescribed for or used by the patient for the purpose of diagnosing, curing, or
preventing a disease.
(2)
"Employer sponsored clinic" means
:
(a)

an entity that has a medical director who is licensed as a physician as defined in
Section
58-67-102
and offers health care only to the employees of an exclusive group
of employers and the employees' dependents
; or
.
(b)
a clinic designated as a clinic for state employees and their dependents by the Public
Employees' Benefit and Insurance Program under the pilot program created by
Section
49-20-413
including all the patients at that clinic, regardless of the patients'
participation in the pilot program.
(3)
"Health care" is as defined in Section
31A-1-301
.
(4)
(a)
"Injectable weight loss drug" means an injectable prescription drug:
(i)
prescribed to promote weight loss; and
(ii)
listed as an injectable prescription drug subject to exemption under this section by
the division by administrative rule.
(b)
"Injectable weight loss drug" does not include a prescription drug that is a controlled
substance.
(5)
"Prepackaged drug" means a prescription drug that:
(a)
is not listed under federal or state law as a Schedule I, II, III, IV, or V drug; and
(b)
is packaged in a fixed quantity per package by:
(i)
the drug manufacturer;
(ii)
a pharmaceutical wholesaler or distributor; or
(iii)
a pharmacy licensed under this title.
Section 48. Section
58-37-6.5
is amended to read:
58-37-6.5
Effective
01/01/28
. Continuing education for controlled substance
prescribers.
(1)
For the purposes of this section:
(a)
"Controlled substance prescriber" means an individual, other than a veterinarian,
who:
(i)
is licensed to prescribe a controlled substance under this chapter; and
(ii)
possesses the authority, in accordance with the individual's scope of practice, to
prescribe schedule II controlled substances and schedule III controlled substances
that are applicable to opioid narcotics, hypnotic depressants, or psychostimulants.
(b)
"D.O." means an osteopathic physician and surgeon licensed under
Chapter 68, Utah
Osteopathic Medical Practice Act
.
(c)
"FDA" means the United States Food and Drug Administration.
(d)
"M.D." means a physician and surgeon licensed under
Chapter 67, Utah Medical
Practice Act
.
(e)
"SBIRT" means the Screening, Brief Intervention, and Referral to Treatment
approach used by the federal Substance Abuse and Mental Health Services
Administration or defined by the division, in consultation with the Office of
Substance Use and Mental Health, by administrative rule, in accordance with
Title
63G, Chapter 3, Utah Administrative Rulemaking Act
.
(2)
(a)
Beginning with the licensing period that begins after January 1, 2014, as a
condition precedent for license renewal, each controlled substance prescriber shall
complete at least 3.5 continuing education hours per licensing period that satisfy the
requirements of Subsection
(3)
.
(b)
(i)
Beginning with the licensing period that begins after January 1, 2024, as a
condition precedent for license renewal, each controlled substance prescriber shall
complete at least 3.5 continuing education hours in an SBIRT-training class that
satisfies the requirements of Subsection
(4)
.
(ii)
Completion of the SBIRT-training class, in compliance with Subsection
(2)(b)(i)
,
fulfills the continuing education hours requirement in Subsection
(3)
for the
licensing period in which the class was completed.
(iii)
A controlled substance prescriber:
(A)
need only take the SBIRT-training class once during the controlled substance
prescriber's licensure in the state; and
(B)
shall provide a completion record of the SBIRT-training class in order to be
reimbursed for SBIRT services to patients, in accordance with Sections
26B-3-131
and
49-20-416
26C-5-102
.
(3)
A controlled substance prescriber shall complete at least 3.5 hours of continuing
education in one or more controlled substance prescribing classes, except dentists who
shall complete at least two hours, that satisfy the requirements of Subsections
(4)
and
(6)
.
(4)
A controlled substance prescribing class shall:
(a)
satisfy the division's requirements for the continuing education required for the
renewal of the controlled substance prescriber's respective license type;
(b)
be delivered by an accredited or approved continuing education provider recognized
by the division as offering continuing education appropriate for the controlled
substance prescriber's respective license type; and
(c)
include a postcourse knowledge assessment.
(5)
An M.D. or D.O. completing continuing professional education hours under Subsection
(4)
shall complete those hours in classes that qualify for the American Medical
Association Physician's Recognition Award Category 1 Credit.
(6)
The 3.5 hours of the controlled substance prescribing classes under Subsection
(4)
shall
include educational content covering the following:
(a)
the scope of the controlled substance abuse problem in Utah and the nation;
(b)
all elements of the FDA Blueprint for Prescriber Education under the FDA's
Extended-Release and Long-Acting Opioid Analgesics Risk Evaluation and
Mitigation Strategy, as published July 9, 2012, or as it may be subsequently revised;
(c)
the national and Utah-specific resources available to prescribers to assist in
appropriate controlled substance and opioid prescribing;
(d)
patient record documentation for controlled substance and opioid prescribing;
(e)
office policies, procedures, and implementation; and
(f)
some training regarding medical cannabis, as that term is defined in Section
26B-4-201
.
(7)
(a)
The division, in consultation with the Utah Medical Association Foundation, shall
determine whether a particular controlled substance prescribing class satisfies the
educational content requirements of Subsections
(4)
and
(6)
for an M.D. or D.O.
(b)
The division, in consultation with the applicable professional licensing boards, shall
determine whether a particular controlled substance prescribing class satisfies the
educational content requirements of Subsections
(4)
and
(6)
for a controlled
substance prescriber other than an M.D. or D.O.
(c)
The division may by rule establish a committee that may audit compliance with the
Utah Risk Evaluation and Mitigation Strategy (REMS) Educational Programming
Project grant, that satisfies the educational content requirements of Subsections
(4)

and
(6)
for a controlled substance prescriber.
(d)
The division shall consult with the Department of Health and Human Services
regarding the medical cannabis training described in Subsection
(6)(f)
.
(8)
A controlled substance prescribing class required under this section:
(a)
may be held:
(i)
in conjunction with other continuing professional education programs; and
(ii)
online; and
(b)
does not increase the total number of state-required continuing professional
education hours required for prescriber licensing.
(9)
The division may establish rules, in accordance with
Title 63G, Chapter 3, Utah
Administrative Rulemaking Act
, to implement this section.
(10)
A controlled substance prescriber who, on or after July 1, 2017, obtains a waiver to
treat opioid dependency with narcotic medications, in accordance with the Drug
Addiction Treatment Act of 2000, 21 U.S.C. Sec. 823 et seq., may use the waiver to
satisfy the 3.5 hours of the continuing education requirement under Subsection
(3)
for
two consecutive licensing periods.
Section 49. Section
59-35-101
is enacted to read:
35. Utah Health Care Tax
59-35-101
Effective
01/01/28
. Definitions.
As used in this section:
(1)
"Corporation" means any of the following:
(a)
a domestic corporation; or
(b)
a foreign corporation.
(2)
"Domestic corporation" means the same as that term is defined in Section
59-7-101
.
(3)
"Foreign corporation" means the same as that term is defined in Section
59-7-101
.
(4)
"Fund" means the Utah Cares Trust Fund created in Section
26C-1-103
.
(5)
(a)
"Gross margin" means the direct cost of producing a good or providing a service.
(b)
"Gross margin" does not include any indirect cost that may be used to calculate net
margin.
(6)
"Gross receipts" means the totality of the money that an entity receives for any good or
service produced or rendered in the state without any deduction.
(7)
"Pass-through entity" means the same as that term is defined in Section
59-10-1402
.
Section 50. Section
59-35-102
is enacted to read:
59-35-102
Effective
01/01/28
. Application -- Utah source-- Credit.
(1)
There is created a tax on gross receipts of corporations and pass-through entities.
(2)
For a domestic corporation or a pass-through entity that is commercially domiciled in
this state, the tax is applicable to all gross receipts of the domestic corporation or
pass-through entity.
(3)
For a foreign corporation or a pass-through entity not described in Subsection
(2)
, the
tax on gross receipts is applicable to gross receipts derived from Utah sources
attributable to or resulting from:
(a)
the ownership in this state of any interest in real or tangible personal property,
including real property or property rights from which gross receipts from mining as
described by Section 613(c), Internal Revenue Code, is derived; and
(b)
the carrying on of a business, trade, profession, or occupation in this state.
(4)
If a domestic corporation or pass-through entity described in Subsection
(2)
pays a gross
receipts tax in another state for sales deriving in that state, the domestic corporation or
pass-through entity described in Subsection
(2)
may claim a credit for a tax collected
under this chapter in an amount equal to the amount of gross receipts tax paid in the
other state.
Section 51. Section
59-35-103
is enacted to read:
59-35-103
Effective
01/01/28
. Rates.
(1)
Except as provided in Subsection
(2)
, the gross receipts tax shall be calculated as
follows on each dollar of gross receipts:
(a)
0% on the first $10,000;
(b)
2% on the amount between $10,001 and $100,000;
(c)
2.5% on the amount between $100,001 and $1,000,000; and
(d)
2.85% on any amount over $1,000,000.
(2)
If the total amount of the tax required by Subsection
(1)
that a corporation or
pass-through entity is liable for exceeds the corporation's or pass-through entity's gross
margin, the corporation or pass-through entity shall pay an amount in tax that is equal to
the entity's gross margin.
Section 52. Section
59-35-104
is enacted to read:
59-35-104
Effective
01/01/28
. Commission duties -- Rulemaking.
(1)
The commission shall deposit all revenue collected or received by the commission
under this chapter into the fund at least monthly.
(2)
The commission may make rules in accordance with Title 63G, Chapter 3,
Administrative Rulemaking Act, to effectuate this chapter.
Section 53. Section
59-35-105
is enacted to read:
59-35-105
Effective
01/01/28
. Filing -- Taxable year.
(1)
Each taxpayer upon whom a gross receipts tax is imposed under this chapter shall file a
return with and pay the tax reflected in the return to the commission annually.
(2)
A taxpayer's taxable year under this chapter is the taxpayer's fiscal year.
(3)
A taxpayer shall file a return no later than 90 days from the day on which the tax payer's
fiscal year ends.
Section 54. Section
59-35-106
is enacted to read:
59-35-106
Effective
01/01/28
. Timely mailing treating as timely filing.
(1)
(a)
A return, claim, statement, other document, or payment is considered mailed on
the date of the postmark.
(b)
Subsection
(1)(a)
shall apply only if:
(i)
the postmark date falls within the prescribed period or on or before the prescribed
date:
(A)
for the filing of the return, claim, statement, or other document; or
(B)
for making the payment; and
(ii)
the return, claim, statement, other document, or payment, was, within the time
prescribed in Subsection
(1)(b)(i)
, deposited in the mail in the United States in an
envelope or other appropriate wrapper, postage prepaid, properly addressed to the
agency, officer, or office with which the return, claim, statement, or other
document is required to be filed, or to which such payment is required to be made.
(2)
This section shall apply in the case of postmarks not made by the United States Postal
Service only if and to the extent provided by rules prescribed by the commission.
(3)
(a)
For purposes of this section, if any such return, claim, statement, other document,
or payment is sent by United States registered mail:
(i)
such registration shall be prima facie evidence that the return, claim, statement, or
other document was delivered to the agency, officer, or office to which addressed;
and
(ii)
the date of registration shall be deemed the postmark date.
(b)
The commission may provide by rule the extent to which the provisions of
Subsection
(3)(a)
with respect to prima facie evidence of delivery and the postmark
date shall apply to certified mail.
(4)
This section does not apply with respect to currency or other medium of payment unless
actually received and accounted for.
(5)
(a)
If any deposit required to be made on or before a prescribed date is, after such
date, delivered by the United States mail to the commission, such deposit shall be
deemed received by the commission on the date the deposit was mailed.
(b)
Subsection
(5)(a)
applies only if the person required to make the deposit establishes
that:
(i)
the date of mailing falls on or before the second day before the prescribed date for
making the deposit, including any extension of time granted for making the
deposit; and
(ii)
the deposit was, on or before such second day, mailed in the United States in an
envelope or other appropriate wrapper, postage prepaid, properly addressed to the
commission.
Section 55. Section
59-35-107
is enacted to read:
59-35-107
Effective
01/01/28
. Place for filing returns.
When not otherwise provided for by this chapter, the commission shall by rule made in
accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, prescribe the
place and for the filing of any return, statement, or other documents, required by this chapter
or rules.
Section 56. Section
59-35-108
is enacted to read:
59-35-108
Effective
01/01/28
. Time and place for paying tax.
(1)
If a taxpayer under this chapter obtains an extension under Section
59-35-109
, the
taxpayer shall pay an amount equal to the previous year's tax required under this chapter
when the tax is due.
(2)
The taxpayer that pays under Subsection
(1)
shall pay the difference of the tax owed or
receive a refund of the amount of tax overpaid when the taxpayer files the return.
Section 57. Section
59-35-109
is enacted to read:
59-35-109
Effective
01/01/28
. Extension.
(1)
The commission shall allow a taxpayer an extension of time for filing a return.
(2)
An extension described in Subsection
(1)
may be up to six months.
Section 58. Section
63A-17-804
is amended to read:
63A-17-804
Effective
01/01/28
. Continuation of Insurance Benefits Program --
Creation -- Coverage following death in the line of duty.
(1)
There is created the "Continuation of Insurance Benefits Program" to provide a
continuation of insurance to the surviving spouse and family of any state employee
whose death occurs in the line of duty.
(2)
The insurance coverage shall be the same coverage as provided under Section
49-20-406
26C-7-101
.
(3)
The program provides that unused accumulated sick leave of a deceased employee may
be used for additional medical coverage in the same manner as provided under Section
63A-17-507
or
63A-17-508
as applicable.
Section 59. Section
63C-31-102
is amended to read:
63C-31-102
Effective
01/01/28
Repealed
07/01/28
. Creation of State Employee
Benefits Advisory Commission -- Membership.
(1)
There is created the State Employee Benefits Advisory Commission consisting of the
following members:
(a)
one member of the Senate, appointed by the president of the Senate;
(b)
one member of the House of Representatives, appointed by the speaker of the House
of Representatives;
(c)
the director of the Division of Human Resource Management, created in Section
63A-17-105
, or the director's designee;
(d)
the executive director of the Governor's Office of Planning and Budget, created in
Section
63J-4-201
, or the executive director's designee;
(e)
the following four individuals who are not employed by the state or another public
entity and are appointed jointly by the president of the Senate and speaker of the
House of Representatives:
(i)
an individual who has experience in health insurance benefits in the private sector;
(ii)
an individual who has experience in business and employee benefits in the private
sector; and
(iii)
a representative of an organization that represents the interests of state
employees; and
(f)
a representative of the
Public Employees' Benefit and Insurance Program
Utah
Cares Health Financing Program
, created in
Section
49-20-103
Title 26C, Utah
Cares Act
, appointed by the
executive director of the Utah State Retirement Office
Utah Health Services Commission
.
(2)
(a)
The member of the Senate appointed under Subsection
(1)(a)
is a cochair of the
benefits advisory commission.
(b)
The member of the House of Representatives appointed under Subsection
(1)(b)
is a
cochair of the benefits advisory commission.
(3)
(a)
Each position described in Subsection
(1)(e)
is for a term of four years.
(b)
A vacancy in a position appointed under Subsection
(1)(a)
,
(b)
,
(e)
, or
(f)
shall be
filled by appointing a replacement member in the same manner as the member
creating the vacancy was appointed under Subsection
(1)(a)
,
(b)
,
(e)
, or
(f)
,
respectively.
(c)
If a position described in Subsection
(1)(e)
is vacant, the president of the Senate and
speaker of the House of Representatives shall jointly appoint the replacement
member for the remainder of the unexpired term.
(4)
(a)
A majority of members constitute a quorum.
(b)
The action of a majority of a quorum constitutes the action of the benefits advisory
commission.
(5)
The benefits advisory commission shall meet as necessary to effectively conduct the
commission's business and duties as prescribed by statute, but not less than twice a year.
(6)
The Division of Human Resource Management shall provide staff support to facilitate
the function of the benefits advisory commission and record the benefits advisory
commission's action and recommendations.
(7)
(a)
The salary and expenses of a benefits advisory commission member who is a
legislator shall be paid in accordance with Section
36-2-2
and Legislative Joint Rules,
Title 5, Legislative Compensation and Expenses
.
(b)
A benefits advisory commission member who is not a legislator may not receive
compensation or benefits for the member's service on the benefits advisory
commission, but may receive per diem and reimbursement for travel expenses
incurred as a benefits advisory commission member at the rates established by the
Division of Finance under:
(i)
Sections
63A-3-106
and
63A-3-107
; and
(ii)
rules made by the Division of Finance under Sections
63A-3-106
and
63A-3-107
.
(8)
The benefits advisory commission shall comply with the provisions of
Title 52, Chapter
4, Open and Public Meetings Act
.
Section 60. Section
63E-1-102
is amended to read:
63E-1-102
Effective
01/01/28
. Definitions -- List of independent entities.
As used in this title:
(1)
"Authorizing statute" means the statute creating an entity as an independent entity.
(2)
"Committee" means the Retirement and Independent Entities Committee created by
Section
63E-1-201
.
(3)
"Independent corporation" means a corporation incorporated in accordance with
Chapter 2, Independent Corporations Act
.
(4)
(a)
"Independent entity" means an entity having a public purpose relating to the state
or its citizens that is individually created by the state or is given by the state the right
to exist and conduct its affairs as an:
(i)
independent state agency; or
(ii)
independent corporation.
(b)
For purposes of this title, the independent entities are the:
(i)
Utah Beef Council, created by Section
4-21-103
;
(ii)
Utah Dairy Commission created by Section
4-22-103
;
(iii)
Heber Valley Historic Railroad Authority created by Section
63H-4-102
;
(iv)
Utah Housing Corporation created by Section
63H-8-201
;
(v)
Utah State Retirement Office created by Section
49-11-201
;
(vi)
School and Institutional Trust Lands Administration created by Section
53C-1-201
;
(vii)
School and Institutional Trust Fund Office created by Section
53D-1-201
;
(viii)
Utah Communications Authority created by Section
63H-7a-201
;
(ix)
Utah Capital Investment Corporation created by Section
63N-6-301
;
(x)
Military Installation Development Authority created by Section
63H-1-201
;
and
(xi)
Public Service Commission of Utah created by Section
54-1-1
.
; and
(xii)
Utah Health Services Commission created by Section
26C-2-101
.
(c)
Notwithstanding this Subsection
(4)
, "independent entity" does not include:
(i)
an institution within the state system of higher education;
(ii)
a city, county, or town;
(iii)
a local school district;
(iv)
a special district under
Title 17B, Limited Purpose Local Government Entities -
Special Districts
; or
(v)
a special service district under
Title 17D, Chapter 1, Special Service District Act
.
(5)
"Independent state agency" means an entity that is created by the state, but is
independent of the governor's direct supervisory control.
(6)
"Money held in trust" means money maintained for the benefit of:
(a)
one or more private individuals, including public employees;
(b)
one or more public or private entities; or
(c)
the owners of a quasi-public corporation.
(7)
"Public corporation" means an artificial person, public in ownership, individually
created by the state as a body politic and corporate for the administration of a public
purpose relating to the state or its citizens.
(8)
"Quasi-public corporation" means an artificial person, private in ownership, individually
created as a corporation by the state, which has accepted from the state the grant of a
franchise or contract involving the performance of a public purpose relating to the state
or its citizens.
Section 61. Section
63G-2-103
is amended to read:
63G-2-103
Effective
01/01/28
. Definitions.
As used in this chapter:
(1)
"Audit" means:
(a)
a systematic examination of financial, management, program, and related records for
the purpose of determining the fair presentation of financial statements, adequacy of
internal controls, or compliance with laws and regulations; or
(b)
a systematic examination of program procedures and operations for the purpose of
determining their effectiveness, economy, efficiency, and compliance with statutes
and regulations.
(2)
"Chief administrative officer" means the chief administrative officer of a governmental
entity who is responsible to fulfill the duties described in Section
63A-12-103
.
(3)
"Chronological logs" mean the regular and customary summary records of law
enforcement agencies and other public safety agencies that show:
(a)
the time and general nature of police, fire, and paramedic calls made to the agency;
and
(b)
any arrests or jail bookings made by the agency.
(4)
"Classification," "classify," and their derivative forms mean determining whether a
record series, record, or information within a record is public, private, controlled,
protected, or exempt from disclosure under Subsection
63G-2-201(3)(b)
.
(5)
(a)
"Computer program" means:
(i)
a series of instructions or statements that permit the functioning of a computer
system in a manner designed to provide storage, retrieval, and manipulation of
data from the computer system; and
(ii)
any associated documentation and source material that explain how to operate the
computer program.
(b)
"Computer program" does not mean:
(i)
the original data, including numbers, text, voice, graphics, and images;
(ii)
analysis, compilation, and other manipulated forms of the original data produced
by use of the program; or
(iii)
the mathematical or statistical formulas, excluding the underlying mathematical
algorithms contained in the program, that would be used if the manipulated forms
of the original data were to be produced manually.
(6)
(a)
"Contractor" means:
(i)
any person who contracts with a governmental entity to provide goods or services
directly to a governmental entity; or
(ii)
any private, nonprofit organization that receives funds from a governmental entity.
(b)
"Contractor" does not mean a private provider.
(7)
"Controlled record" means a record containing data on individuals that is controlled as
provided by Section
63G-2-304
.
(8)
"Designation," "designate," and their derivative forms mean indicating, based on a
governmental entity's familiarity with a record series or based on a governmental entity's
review of a reasonable sample of a record series, the primary classification that a
majority of records in a record series would be given if classified and the classification
that other records typically present in the record series would be given if classified.
(9)
"Elected official" means each person elected to a state office, county office, municipal
office, school board or school district office, special district office, or special service
district office, but does not include judges.
(10)
"Explosive" means a chemical compound, device, or mixture:
(a)
commonly used or intended for the purpose of producing an explosion; and
(b)
that contains oxidizing or combustive units or other ingredients in proportions,
quantities, or packing so that:
(i)
an ignition by fire, friction, concussion, percussion, or detonator of any part of the
compound or mixture may cause a sudden generation of highly heated gases; and
(ii)
the resultant gaseous pressures are capable of:
(A)
producing destructive effects on contiguous objects; or
(B)
causing death or serious bodily injury.
(11)
"Government audit agency" means any governmental entity that conducts an audit.
(12)
(a)
"Governmental entity" means:
(i)
executive department agencies of the state, the offices of the governor, lieutenant
governor, state auditor, attorney general, and state treasurer, the Board of Pardons
and Parole, the Board of Examiners, the National Guard, the Career Service
Review Office, the State Board of Education, the Utah Board of Higher
Education, and the State Archives;
(ii)
the Office of the Legislative Auditor General, Office of the Legislative Fiscal
Analyst, Office of Legislative Research and General Counsel, the Legislature, and
legislative committees, except any political party, group, caucus, or rules or sifting
committee of the Legislature;
(iii)
courts, the Judicial Council, the Administrative Office of the Courts, and similar
administrative units in the judicial branch;
(iv)
any state-funded institution of higher education or public education; or
(v)
any political subdivision of the state, but, if a political subdivision has adopted an
ordinance or a policy relating to information practices
pursuant to
Section
63G-2-701
, this chapter shall apply to the political subdivision to the extent
specified in Section
63G-2-701
or as specified in any other section of this chapter
that specifically refers to political subdivisions.
(b)
"Governmental entity" also means:
(i)
every office, agency, board, bureau, committee, department, advisory board, or
commission of an entity listed in Subsection
(12)(a)
that is funded or established
by the government to carry out the public's business;
(ii)
as defined in Section
11-13-103
, an interlocal entity or joint or cooperative
undertaking, except for the Water District Water Development Council created
pursuant to
Section
11-13-228
;
(iii)
as defined in Section
11-13a-102
, a governmental nonprofit corporation;
(iv)
an association as defined in Section
53G-7-1101
;
(v)
the Utah Independent Redistricting Commission; and
(vi)
a law enforcement agency, as defined in Section
53-1-102
, that employs one or
more law enforcement officers, as defined in Section
53-13-103
.
(c)
"Governmental entity" does not include the Utah Educational Savings Plan created in
Section
53H-10-202
.
(13)
"Government Records Office" means the same as that term is defined in Section
63A-12-201
.
(14)
"Gross compensation" means every form of remuneration payable for a given period to
an individual for services provided including salaries, commissions, vacation pay,
severance pay, bonuses, and any board, rent, housing, lodging, payments in kind, and
any similar benefit received from the individual's employer.
(15)
"Individual" means a human being.
(16)
(a)
"Initial contact report" means an initial written or recorded report, however
titled, prepared by peace officers engaged in public patrol or response duties
describing official actions initially taken in response to either a public complaint
about or the discovery of an apparent violation of law, which report may describe:
(i)
the date, time, location, and nature of the complaint, the incident, or offense;
(ii)
names of victims;
(iii)
the nature or general scope of the agency's initial actions taken in response to the
incident;
(iv)
the general nature of any injuries or estimate of damages sustained in the incident;
(v)
the name, address, and other identifying information about any person arrested or
charged in connection with the incident; or
(vi)
the identity of the public safety personnel, except undercover personnel, or
prosecuting attorney involved in responding to the initial incident.
(b)
Initial contact reports do not include follow-up or investigative reports prepared after
the initial contact report. However, if the information specified in Subsection
(16)(a)

appears in follow-up or investigative reports, it may only be treated confidentially if
it is private, controlled, protected, or exempt from disclosure under Subsection
63G-2-201(3)(b)
.
(c)
Initial contact reports do not include accident reports, as that term is described in
Title
41, Chapter 6a, Part 4
, Accident Responsibilities.
(17)
"Legislative body" means the Legislature.
(18)
"Notice of compliance" means a statement confirming that a governmental entity has
complied with an order of the director of the Government Records Office.
(19)
"Person" means:
(a)
an individual;
(b)
a nonprofit or profit corporation;
(c)
a partnership;
(d)
a sole proprietorship;
(e)
other type of business organization; or
(f)
any combination acting in concert with one another.
(20)
"Private provider" means any person who contracts with a governmental entity to
provide services directly to the public.
(21)
"Private record" means a record containing data on individuals that is private as
provided by Section
63G-2-302
.
(22)
"Protected record" means a record that is classified protected as provided by Section
63G-2-305
.
(23)
"Public record" means a record that is not private, controlled, or protected and that is
not exempt from disclosure as provided in Subsection
63G-2-201(3)(b)
.
(24)
"Reasonable search" means a search that is:
(a)
reasonable in scope and intensity; and
(b)
not unreasonably burdensome for the government entity.
(25)
(a)
"Record" means a book, letter, document, paper, map, plan, photograph, film,
card, tape, recording, electronic data, or other documentary material regardless of
physical form or characteristics:
(i)
that is prepared, owned, received, or retained by a governmental entity or political
subdivision; and
(ii)
where all of the information in the original is reproducible by photocopy or other
mechanical or electronic means.
(b)
"Record" does not include:
(i)
a personal note or personal communication prepared or received by an employee
or officer of a governmental entity:
(A)
in a capacity other than the employee's or officer's governmental capacity; or
(B)
that is unrelated to the conduct of the public's business;
(ii)
a temporary draft or similar material prepared for the originator's personal use or
prepared by the originator for the personal use of an individual for whom the
originator is working;
(iii)
material that is legally owned by an individual in the individual's private capacity;
(iv)
material to which access is limited by the laws of copyright or patent unless the
copyright or patent is owned by a governmental entity or political subdivision;
(v)
proprietary software;
(vi)
junk mail or a commercial publication received by a governmental entity or an
official or employee of a governmental entity;
(vii)
a book that is cataloged, indexed, or inventoried and contained in the collections
of a library open to the public;
(viii)
material that is cataloged, indexed, or inventoried and contained in the
collections of a library open to the public, regardless of physical form or
characteristics of the material;
(ix)
a daily calendar ;
(x)
a note prepared by the originator for the originator's own use or for the sole use of
an individual for whom the originator is working;
(xi)
a computer program that is developed or purchased by or for any governmental
entity for its own use;
(xii)
a note or internal memorandum prepared as part of the deliberative process by:
(A)
a member of the judiciary;
(B)
an administrative law judge;
(C)
a member of the Board of Pardons and Parole; or
(D)
a member of any other body, other than an association or appeals panel as
defined in Section
53G-7-1101
, charged by law with performing a
quasi-judicial function;
(xiii)
a telephone number or similar code used to access a mobile communication
device that is used by an employee or officer of a governmental entity, provided
that the employee or officer of the governmental entity has designated at least one
business telephone number that is a public record as provided in Section
63G-2-301
;
(xiv)
information provided by the Public Employees' Benefit and Insurance
Program, created in Section
49-20-103
, to a county to enable the county to
calculate the amount to be paid to a health care provider under Subsection
17-63-706(2)(e)(ii)
;
(xv)
(xiv)
information that an owner of unimproved property provides to a local
entity as provided in Section
11-42-205
;
(xvi)
(xv)
a video or audio recording of an interview, or a transcript of the video or
audio recording, that is conducted at a Children's Justice Center established under
Section
67-5b-102
;
(xvii)
(xvi)
child sexual abuse material, as defined by Section
76-5b-103
;
(xviii)
(xvii)
before final disposition of an ethics complaint occurs, a video or audio
recording of the closed portion of a meeting or hearing of:
(A)
a Senate or House Ethics Committee;
(B)
the Independent Legislative Ethics Commission;
(C)
the Independent Executive Branch Ethics Commission, created in Section
63A-14-202
; or
(D)
the Political Subdivisions Ethics Review Commission established in Section
63A-15-201
;
(xix)
(xviii)
confidential communication described in Section
58-60-102
,
58-61-102
,
or
58-61-702
;
(xx)
(xix)
any item described in Subsection
(25)(a)
that is:
(A)
described in Subsection
63G-2-305(17)
,
(18),
or
(23)(b)
; and
(B)
shared between any of the following entities:
(I)
the Division of Risk Management;
(II)
the Office of the Attorney General;
(III)
the governor's office; or
(IV)
the Legislature;
(xxi)
(xx)
the email address that a candidate for elective office provides to a filing
officer under Subsection
20A-9-201(5)(c)(ii)
or
20A-9-203(4)(c)(iv)
; or
(xxii)
(xxi)
except as provided in Sections
31A-16-105
,
31A-16-107.5
, and
27a-3-303
, an investment policy, or information related to an investment policy,
provided to the insurance commissioner as described in Title
31A, Chapter 18
,
Investments.
(26)
"Record series" means a group of records that may be treated as a unit for purposes of
designation, description, management, or disposition.
(27)
"Records officer" means the individual appointed by the chief administrative officer of
each governmental entity, or the political subdivision to work with state archives in the
care, maintenance, scheduling, designation, classification, disposal, and preservation of
records.
(28)
"Schedule," "scheduling," and their derivative forms mean the process of specifying
the length of time each record series should be retained by a governmental entity for
administrative, legal, fiscal, or historical purposes and when each record series should be
transferred to the state archives or destroyed.
(29)
"Sponsored research" means research, training, and other sponsored activities as
defined by the federal Executive Office of the President, Office of Management and
Budget:
(a)
conducted:
(i)
by an institution within the state system of higher education described in Section
53H-1-102
; and
(ii)
through an office responsible for sponsored projects or programs; and
(b)
funded or otherwise supported by an external:
(i)
person that is not created or controlled by the institution within the state system of
higher education; or
(ii)
federal, state, or local governmental entity.
(30)
"State archives" means the Division of Archives and Records Service created in
Section
63A-12-101
.
(31)
"State archivist" means the director of the state archives.
(32)
"Summary data" means statistical records and compilations that contain data derived
from private, controlled, or protected information but that do not disclose private,
controlled, or protected information.
Section 62. Section
63H-9-101
is amended to read:
63H-9-101
Effective
01/01/28
. Definitions.
As used in this chapter:
(1)
"Best practices toolbox" means the collection of resources for governmental entities
provided on the website of the Office of the Legislative Auditor General that includes a
best practice self-assessment and other resources, tools, surveys, and reports designed to
help government organizations better serve the citizens of the state.
(2)
"Consensus group" means the Office of Legislative Research and General Counsel, the
Office of the Legislative Auditor General, and the Office of the Legislative Fiscal
Analyst.
(3)
(a)
"Independent entity" means an entity that:
(i)
has a public purpose relating to the state or its citizens;
(ii)
is individually created by the state;
(iii)
is separate from the judicial and legislative branches of state government; and
(iv)
is not under the direct supervisory control of the governor.
(b)
"Independent entity" does not include an entity that is:
(i)
a county;
(ii)
a municipality as defined in Section
10-1-104
;
(iii)
an institution of higher education as defined in Section
53H-1-101
;
(iv)
a public school as defined in Section
53G-8-701
;
(v)
a special district as defined in Section
17B-1-102
;
(vi)
a special service district as defined in Section
17D-1-102
;
(vii)
created by an interlocal agreement as described in Section
11-13-203
; or
(viii)
an elective constitutional office, including the state auditor, the state treasurer,
and the attorney general.
(c)
Independent entities that are subject to the provisions of this chapter include the:
(i)
Career Service Review Office created in Section
67-19a-201
;
(ii)
State
Capitol Preservation Board
created in Section
63C-9-201
63O-2-201
;
(iii)
Heber Valley Historic Railroad Authority created in Section
63H-4-102
;
(iv)
Military Installation Development Authority created in Section
63H-1-201
;
(v)
Office of Inspector General of Medicaid Services created in Section
63A-13-201
;
(vi)
Point of the Mountain State Land Authority created in Section
11-59-201
;
(vii)
Public Service Commission created in Section
54-1-1
;
(viii)
School and Institutional Trust Fund Office created in Section

53C-1-201
53D-1-201
;
(ix)
School and Institutional Trust Lands Administration created in Section

53D-1-201
53C-1-201
;
(x)
Utah Beef Council created in Section
4-21-103
;
(xi)
Utah Capital Investment Corporation created in Section
63N-6-301
;
(xii)
Utah Communications Authority created in Section
63H-7a-201
;
(xiii)
Utah Dairy Commission created in Section
4-22-103
;
(xiv)
Utah Education and Telehealth Network created in Section
53H-4-213.4
;
(xv)
Utah Housing Corporation created in Section
63H-8-201
;
(xvi)
Utah Inland Port Authority created in Section
11-58-201
;
(xvii)
Utah Lake Authority created in Section
11-65-201
;
(xviii)
Utah Retirement Systems created in Section
49-11-201
;
and
(xix)
Utah
State Fair
Park
Authority created in Section
11-68-201
.
; and
(xx)
Utah Health Services Commission created in Section
26C-2-101
.
Section 63. Section
63I-1-226
is amended to read:
63I-1-226
Effective
01/01/28
. Repeal dates: Titles 26 through 26C.
(1)
Subsection
26B-1-204(2)(g)
, regarding the Youth Electronic Cigarette, Marijuana, and
Other Drug Prevention Committee, is repealed July 1, 2030.
(2)
Subsection
26B-1-204(2)(h)
, regarding the Primary Care Grant Committee, is repealed
July 1, 2035.
(3)
Section
26B-1-315
, Medicaid ACA Fund, is repealed July 1, 2034.
(4)
Section
26B-1-318
, Brain and Spinal Cord Injury Fund, is repealed July 1, 2029.
(5)
Section
26B-1-402
, Rare Disease Advisory Council Grant Program -- Creation --
Reporting, is repealed July 1, 2026.
(6)
Section
26B-1-409
, Utah Digital Health Service Commission -- Creation -- Membership
-- Duties, is repealed July 1, 2025.
(7)
Section
26B-1-410
, Primary Care Grant Committee, is repealed July 1, 2035.
(8)
Section
26B-1-417
, Brain and Spinal Cord Injury Advisory Committee -- Membership
-- Duties, is repealed July 1, 2029.
(9)
Section
26B-1-422
, Early Childhood Utah Advisory Council -- Creation --
Compensation -- Duties, is repealed July 1, 2029.
(10)
Section
26B-1-425
, Utah Health Workforce Advisory Council -- Creation and
membership, is repealed July 1, 2027.
(11)
(10)
Section
26B-1-428
, Youth Electronic Cigarette, Marijuana, and Other Drug
Prevention Committee and Program -- Creation -- Membership -- Duties, is repealed
July 1, 2030.
(12)
(11)
Section
26B-1-430
, Coordinating Council for Persons with Disabilities -- Policy
regarding services to individuals with disabilities -- Creation -- Membership --
Expenses, is repealed July 1, 2027.
(13)
(12)
Section
26B-1-432
, Newborn Hearing Screening Committee, is repealed July 1,
2026.
(14)
(13)
Section
26B-2-407
, Drinking water quality in child care centers, is repealed July
1, 2027.
(15)
(14)
Subsection 26B-3-107(9), regarding reimbursement for dental hygienists, is
repealed July 1, 2028.
(16)
(15)
Section
26B-3-136
, Children's Health Care Coverage Program, is repealed July
1, 2025.
(17)
(16)
Section
26B-3-137
, Reimbursement for diabetes prevention program, is repealed
June 30, 2027.
(18)
(17)
Subsection
26B-3-213(2)(b)
, regarding consultation with the Behavioral Health
Crisis Response Committee, is repealed December 31, 2026.
(19)
(18)
Section
26B-3-302
, DUR Board -- Creation and membership -- Expenses, is
repealed July 1, 2027.
(20)
(19)
Section
26B-3-303
, DUR Board -- Responsibilities, is repealed July 1, 2027.
(21)
(20)
Section
26B-3-304
, Confidentiality of records, is repealed July 1, 2027.
(22)
(21)
Section
26B-3-305
, Drug prior approval program, is repealed July 1, 2027.
(23)
(22)
Section
26B-3-306
, Advisory committees, is repealed July 1, 2027.
(24)
(23)
Section
26B-3-307
, Retrospective and prospective DUR, is repealed July 1, 2027.
(25)
(24)
Section
26B-3-308
, Penalties, is repealed July 1, 2027.
(26)
(25)
Section
26B-3-309
, Immunity, is repealed July 1, 2027.
(27)
(26)
Title 26B, Chapter 3, Part 5, Inpatient Hospital Assessment, is repealed July 1,
2034.
(28)
(27)
Title 26B, Chapter 3, Part 6, Medicaid Expansion Hospital Assessment, is
repealed July 1, 2034.
(29)
(28)
Title 26B, Chapter 3, Part 7, Hospital Provider Assessment, is repealed July 1,
2028.
(30)
(29)
Section
26B-3-910
, Alternative eligibility -- Report -- Alternative Eligibility
Expendable Revenue Fund, is repealed July 1, 2028.
(31)
(30)
Section
26B-4-710
, Rural residency training program, is repealed July 1, 2025.
(32)
(31)
Subsection
26B-5-112(1)(b)
, regarding consultation with the Behavioral Health
Crisis Response Committee, is repealed December 31, 2026.
(33)
(32)
Subsection
26B-5-112(5)(b)
, regarding consultation with the Behavioral Health
Crisis Response Committee, is repealed December 31, 2026.
(34)
(33)
Section
26B-5-112.5
, Mobile Crisis Outreach Team Grant Program, is repealed
December 31, 2026.
(35)
(34)
Section
26B-5-114
, Behavioral Health Receiving Center Grant Program, is
repealed December 31, 2026.
(36)
(35)
Section
26B-5-118
, Collaborative care grant program, is repealed December 31,
2024.
(37)
(36)
Section
26B-5-120
, Virtual crisis outreach team grant program, is repealed
December 31, 2026.
(38)
(37)
Subsection
26B-5-609(1)(a)
, regarding the Behavioral Health Crisis Response
Committee, is repealed December 31, 2026.
(39)
(38)
Subsection
26B-5-609(3)(b)
, regarding the Behavioral Health Crisis Response
Committee, is repealed December 31, 2026.
(40)
(39)
Subsection
26B-5-610(1)(b)
, regarding the Behavioral Health Crisis Response
Committee, is repealed December 31, 2026.
(41)
(40)
Subsection
26B-5-610(2)(b)(ii)
, regarding the Behavioral Health Crisis Response
Committee, is repealed December 31, 2026.
(42)
(41)
Section
26B-5-612
, Integrated behavioral health care grant programs, is repealed
December 31, 2025.
(43)
(42)
Title 26B, Chapter 5, Part 7, Utah Behavioral Health Commission, is repealed
July 1, 2029.
(44)
(43)
Subsection
26B-5-704(2)(a)
, regarding the Behavioral Health Crisis Response
Committee, is repealed December 31, 2026.
(45)
(44)
Title 26B, Chapter 5, Part 8,
Utah Substance Use and Mental Health Advisory
Committee, is repealed January 1, 2033.
(46)
(45)
Section
26B-7-119
, Hepatitis C Outreach Pilot Program, is repealed July 1, 2028.
(47)
(46)
Section
26B-7-122
, Communication Habits to reduce Adolescent Threats Pilot
Program, is repealed July 1, 2029.
(48)
(47)
Section
26B-7-123
, Report on CHAT campaign, is repealed July 1, 2029.
(49)
(48)
Title
26B, Chapter
8, Part
5
, Utah Health Data Authority, is repealed July 1,
2026.
Section 64. Section
63I-2-249
is amended to read:
63I-2-249
Effective
01/01/28
. Repeal dates: Title
49
.
Reserved.
(1)
Subsection 49-20-420(3), regarding a requirement to report to the Legislature, is
repealed January 1, 2030.
(2)
Section 49-20-422, Coverage of pregnancy and childbirth services, including doula,
direct- entry midwife, and birthing center services, is repealed July 1, 2027.
Section 65. Section
63J-1-602.2
is amended to read:
63J-1-602.2
Effective
01/01/28
Partially Repealed
07/01/29
. List of nonlapsing
appropriations to programs.
Appropriations made to the following programs are nonlapsing:
(1)
The Legislature and the Legislature's committees.
(2)
The State Board of Education, including all appropriations to agencies, line items, and
programs under the jurisdiction of the State Board of Education, in accordance with
Section
53F-9-103
.
(3)
The Rangeland Improvement Act created in Section
4-20-101
.
(4)
The Percent-for-Art Program created in Section
9-6-404
.
(5)
The LeRay McAllister Working Farm and Ranch Fund Program created in Title
4,
Chapter 46, Part 3
, LeRay McAllister Working Farm and Ranch Fund.
(6)
The Utah Lake Authority created in Section
11-65-201
.
(7)
Dedicated credits accrued to the Utah Marriage Commission as provided under
Subsection
17-66-303(2)(d)(ii)
.
(8)
The Wildlife Land and Water Acquisition Program created in Section
23A-6-205
.
(9)
Sanctions collected as dedicated credits from Medicaid providers under Subsection
26B-3-108(7)
.
(10)
The primary care grant program created in Section
26B-4-310
.
(11)
The Opiate Overdose Outreach Pilot Program created in Section
26B-4-512
.
(12)
The Utah Health Care Workforce Financial Assistance Program created in Section
26B-4-702
.
(13)
The Rural Physician Loan Repayment Program created in Section
26B-4-703
.
(14)
The Utah Medical Education Council for the:
(a)
administration of the Utah Medical Education Program created in Section
26B-4-707
26C-2-108
;
(b)
provision of medical residency grants described in Section
26B-4-711
26C-2-111
;
and
(c)
provision of the forensic psychiatric fellowship grant described in Section
26B-4-712
26C-2-112
.
(15)
The Division of Services for People with Disabilities, as provided in Section
26B-6-402
.
(16)
The Communication Habits to reduce Adolescent Threats (CHAT) Pilot Program
created in Section
26B-7-122
.
(17)
Funds that the Department of Alcoholic Beverage Services retains in accordance with
Subsection
32B-2-301(8)(a)
or
(b)
.
(18)
The General Assistance program administered by the Department of Workforce
Services, as provided in Section
35A-3-401
.
(19)
The Utah National Guard, created in Title
39A, National Guard and Militia Act
.
(20)
The Search and Rescue Financial Assistance Program, as provided in Section
53-2a-1102
.
(21)
The Emergency Medical Services Grant Program, as provided in Section
53-2d-207
.
(22)
The Motorcycle Rider Education Program, as provided in Section
53-3-905
.
(23)
The Utah Board of Higher Education for teacher preparation programs, as provided in
Section
53H-5-402
.
(24)
Innovation grants under Section
53G-10-608
, except as provided in Subsection
53G-10-608(3)
.
(25)
The Division of Fleet Operations for the purpose of upgrading underground storage
tanks under Section
63A-9-401
.
(26)
The Division of Technology Services for technology innovation as provided under
Section
63A-16-903
.
(27)
The State Capitol Preservation Board created by Section
63O-2-201
.
(28)
The Office of Administrative Rules for publishing, as provided in Section
63G-3-402
.
(29)
The Colorado River Authority of Utah, created in Title
63M, Chapter 14
, Colorado
River Authority of Utah Act.
(30)
The Governor's Office of Economic Opportunity to fund the Enterprise Zone Act, as
provided in Title
63N, Chapter 2, Part 2
, Enterprise Zone Act.
(31)
The Governor's Office of Economic Opportunity's Rural Employment Expansion
Program, as described in Title
63N, Chapter 4, Part 4
, Rural Employment Expansion
Program.
(32)
County correctional facility contracting program for state inmates as described in
Section
64-13e-103
.
(33)
County correctional facility reimbursement program for state probationary inmates and
state parole inmates as described in Section
64-13e-104
.
(34)
Programs for the Jordan River Recreation Area as described in Section
65A-2-8
.
(35)
The Division of Human Resource Management user training program, as provided in
Section
63A-17-106
.
(36)
A public safety answering point's emergency telecommunications service fund, as
provided in Section
69-2-301
.
(37)
The Traffic Noise Abatement Program created in Section
72-6-112
.
(38)
The money appropriated from the Navajo Water Rights Negotiation Account to the
Division of Water Rights, created in Section
73-2-1.1
, for purposes of participating in a
settlement of federal reserved water right claims.
(39)
The Judicial Council for compensation for special prosecutors, as provided in Section
77-10a-19
.
(40)
A state rehabilitative employment program, as provided in Section
78A-6-210
.
(41)
The Utah Geological Survey, as provided in Section
79-3-401
.
(42)
The Bonneville Shoreline Trail Program created under Section
79-5-503
.
(43)
Adoption document access as provided in Sections
81-13-103
,
81-13-504
, and
81-13-505
.
(44)
Indigent defense as provided in Title
78B, Chapter 22, Part 4
, Utah Indigent Defense
Commission.
(45)
The program established by the Division of Facilities Construction and Management
under Section
63A-5b-703
under which state agencies receive an appropriation and pay
lease payments for the use and occupancy of buildings owned by the Division of
Facilities Construction and Management.
(46)
The State Tax Commission for reimbursing counties for deferrals in accordance with
Section
59-2-1802.5
.
(47)
The Veterinarian Education Loan Repayment Program created in Section
4-2-902
.
Section 66. Section
63J-7-102
is amended to read:
63J-7-102
Effective
01/01/28
. Scope and applicability of chapter.
(1)
Except as provided in Subsection
(2)
, and except as otherwise provided by a statute
superseding provisions of this chapter by explicit reference to this chapter, the
provisions of this chapter apply to each agency and govern each grant received on or
after May 5, 2008.
(2)
This chapter does not govern:
(a)
a grant deposited into a General Fund restricted account;
(b)
a grant deposited into a Fiduciary Fund as defined in Section
51-5-4
;
(c)
a grant deposited into an Enterprise Fund as defined in Section
51-5-4
;
(d)
a grant made to the state without a restriction or other designated purpose that is
deposited into the General Fund as free revenue;
(e)
a grant made to the state that is restricted only to "education" and that is deposited
into the Income Tax Fund or Uniform School Fund as free revenue;
(f)
in-kind donations;
(g)
a tax, fees, penalty, fine, surcharge, money judgment, or other money due the state
when required by state law or application of state law;
(h)
a contribution made under Title 59, Chapter 10, Part 13, Individual Income Tax
Contribution Act;
(i)
a grant received by an agency from another agency or political subdivision;
(j)
a grant to the Utah Dairy Commission created in Section
4-22-103
;
(k)
a grant to the Heber Valley Historic Railroad Authority created in Section
63H-4-102
;
(l)
a grant to the Utah State Railroad Museum Authority created in Section
63H-5-102
;
(m)
a grant to the Utah Housing Corporation created in Section
63H-8-201
;
(n)
a grant to the State Fair Park Authority created in Section
11-68-201
;
(o)
a grant to the Utah State Retirement Office created in Section
49-11-201
;
(p)
a grant to the School and Institutional Trust Lands Administration created in Section
53C-1-201
;
(q)
a grant to the Utah Communications Authority created in Section
63H-7a-201
;
(r)
a grant to the Medical Education Program created in Section
26B-4-707
26C-2-108
;
(s)
a grant to the Utah Capital Investment Corporation created in Section
63N-6-301
;
(t)
a grant to the Utah Charter School Finance Authority created in Section
53G-5-602
;
(u)
a grant to the State Building Ownership Authority created in Section
63B-1-304
; or
(v)
a grant to the Military Installation Development Authority created in Section
63H-1-201
.
(3)
An agency need not seek legislative review or approval of grants under Part 2, Grant
Approval Requirements, if:
(a)
the governor has declared a state of emergency; and
(b)
the grant is donated to the agency to assist victims of the state of emergency under
Subsection
53-2a-204(1)
.
Section 67. Section
64-13-30
is amended to read:
64-13-30
Effective
01/01/28
. Expenses incurred by offenders -- Payment to
department or county jail -- Medical care expenses and copayments.
(1)
(a)
The department or county jail may require an inmate to make a copayment for
medical and dental services provided by the department or county jail.
(b)
For services provided while in the custody of the department, the copayment by the
inmate is $5 for primary medical care, $5 for dental care, and $2 for prescription
medication.
(c)
For services provided outside of a prison facility while in the custody of the
department, the offender is responsible for 10% of the costs associated with hospital
care with a cap on an inmate's share of hospital care expenses not to exceed $2,000
per fiscal year.
(2)
(a)
An inmate who has assets exceeding $200,000, as determined by the department
upon entry into the department's custody, is responsible to pay the costs of all
medical and dental care up to 20% of the inmate's total determined asset value.
(b)
After an inmate has received medical and dental care equal to 20% of the inmate's
total asset value, the inmate is subject to the copayments provided in Subsection
(1)
.
(3)
The department shall turn over to the Office of State Debt Collection any debt under
this section that is unpaid at the time the offender is released from parole.
(4)
An inmate may not be denied medical treatment if the inmate is unable to pay for the
treatment because of inadequate financial resources.
(5)
When an offender in the custody of the department receives medical care that is
provided outside of a prison facility, the department shall pay the costs:
(a)
at the contracted rate; or
(b)
(i)
if there is no contract between the department and a health care facility that
establishes a fee schedule for medical services rendered
or the individual is not an
enrollee described in Subsection
(6)(a)
, expenses shall be at the noncapitated state
Medicaid rate in effect at the time the service was provided; and
(ii)
if there is no contract between the department and a health care provider that
establishes a fee schedule for medical services rendered, expenses shall be 65% of
the amount that would be paid under the
Public Employees' Benefit and
Insurance Program, created in Section 49-20-103
Utah Cares Health Financing
Program, created in Title
26C
, Utah Cares Act
.
(6)
(a)
A jail shall ensure that each inmate is enrolled in the Utah Cares Health Financing
Program if the inmate is eligible for enrollment when enrollment opens on January 1,
2029.
(b)
Expenses described in Subsection
(5)
are a cost to the department only to the extent
that they exceed an offender's private insurance that is in effect at the time of the
service and that covers those expenses.
(7)
(a)
The
Public Employees' Benefit and Insurance Program shall provide information
to the department that enables the department to
Utah Cares Health Financing
Program shall
calculate the amount to be paid to a health care provider under
Subsection
(5)(b)
.
(b)
The department shall ensure that information provided under Subsection
(7)(a)
is
confidential.
Section 68. Section
67-19d-201.5
is amended to read:
67-19d-201.5
Effective
01/01/28
. Elected Official Post-Retirement Benefits
Trust Fund -- Creation -- Oversight -- Dissolution.
(1)
There is created the "Elected Official Post-Retirement Benefits Trust Fund."
(2)
The Elected Official Post-Retirement Benefits Trust Fund consists of:
(a)
appropriations made to the fund by the Legislature for the purpose of funding the
post-retirement benefits in Section
49-20-404
;
(b)
revenues received by the state treasurer from the investment of the Elected Official
Post-Retirement Benefits Trust Fund; and
(c)
other revenues received from other sources.
(3)
The Division of Finance shall account for the receipt and expenditures of money in the
Elected Official Post-Retirement Benefits Trust Fund.
(4)
(a)
Except as provided in Subsection
(4)(c)
, the state treasurer shall invest the Elected
Official Post-Retirement Benefits Trust Fund money by following the same
procedures and requirements for the investment of the State Post-Retirement Benefits
Trust Fund in Part 3, Trust Fund Investments.
(b)
(i)
The Elected Official Post-Retirement Benefits Trust Fund shall earn interest.
(ii)
The state treasurer shall deposit all interest or other income earned from
investment of the Elected Official Post-Retirement Benefits Trust Fund back into
the Elected Official Post-Retirement Benefits Trust Fund.
(c)
The Elected Official Post-Retirement Benefits Trust Fund is exempt from Title 51,
Chapter 7, State Money Management Act.
(5)
The board of trustees created in Section
67-19d-202
may expend money from the
Elected Official Post-Retirement Benefits Trust Fund for:
(a)
the employer portion of the cost of the program established in Section
49-20-404
67-19d-201.6
; and
(b)
reasonable administrative costs that the board of trustees incurs in performing its
duties as trustees of the Elected Official Post-Retirement Benefits Trust Fund.
(6)
The board of trustees shall ensure that:
(a)
money deposited into the Elected Official Post-Retirement Benefits Trust Fund is
irrevocable and is expended only for the employer portion of the costs of
post-retirement benefits under Section
49-20-404
; and
(b)
creditors of the board of trustees and of employers liable for the post-retirement
benefits may not seize, attach, or otherwise obtain assets of the Elected Official
Post-Retirement Benefits Trust Fund.
(7)
When all of the liabilities for which the Elected Official Post-Retirement Benefits Trust
Fund was created are paid, the Division of Finance shall transfer any assets remaining in
the Elected Official Post-Retirement Benefits Trust Fund into the appropriate fund.
Section 69. Section
67-19d-201.6
, which is renumbered from Section 49-20-404 is renumbered
and amended to read:
49-20-404
67-19d-201.6
Effective
01/01/28
. Governors' and legislative paid-up
group health coverage benefit -- Limitations -- Medicare supplemental coverage --
Spouse coverage -- Limitations.
(1)
(a)
Except as provided under Subsection
(1)(b)
, the state shall pay the percentage of
the cost of providing paid-up group health coverage under Subsection
(3)
for
members and their surviving spouses covered under
Title 49,
Chapter 19, Utah
Governors' and Legislators' Retirement Act, or governors and legislators, as defined
in Section
49-19-102
, and their surviving spouses covered under Chapter 22, New
Public Employees' Tier II Contributory Retirement Act, who:
(i)
retire after January 1, 1998;
(ii)
are at least 62 but less than 65 years
of age
old
;
(iii)
elect to receive and apply for this benefit to the program; and
(iv)
are active members at the time of retirement or have continued coverage with the
program until the date of eligibility for the benefit under this Subsection
(1)
.
(b)
A governor or a legislator who begins service as a governor or legislator on or after
January 1, 2012, and a surviving spouse of the governor or the legislator who begins
service as a governor or legislator on or after January 1, 2012, is not eligible for the
benefit provided under this Subsection
(1)
.
(2)
The state shall pay the percentage of the cost of providing Medicare supplemental
coverage under Subsection
(3)
for members and their surviving spouses covered under
Title 49,
Chapter 19, Utah Governors' and Legislators' Retirement Act who:
(a)
began service as a governor or legislator before July 1, 2013;
(b)
retire after January 1, 1998;
(c)
are at least 65 years
of age
old
; and
(d)
elect to receive and apply for this benefit to the program.
(3)
The following percentages apply to the benefit described in Subsections
(1)(a)
and
(2)
:
(a)
100% if the member has accrued 10 or more years of service credit;
(b)
80% if the member has accrued 8 or more years of service credit;
(c)
60% if the member has accrued 6 or more years of service credit; and
(d)
40% if the member has accrued 4 or more years of service credit.
Section 70.
Repealer.
Definitions.
Coverage of diabetes.
Coverage of epinephrine auto-injector.
Title.
Definitions.
Creation of insurance program.
Creation of fund.
Purpose -- Benefits are not a continuing obligation.
Program participation -- Eligibility -- Optional for certain groups.
Establishment of separate risk pools.
Payments made by employer and employee.
Program -- Powers and duties.
Reserves to be held -- Refunds.
Assistance to members in purchase of life, health, dental, and
medical insurance after retirement -- Employment of personnel to administer section.
Audit required -- Report to governor and Legislature.
Insurance mandates.
Time to add child to plan.
Long-term disability -- Cost of health coverage benefit.
High deductible health plan -- Health savings account --
Contributions.
Pilot program for on-site employee clinic.
Telemedicine services -- Reimbursement -- Reporting.
Insurance coverage for amino acid-based formula.
Prescription discount program.
Title.
Definitions.
Request for proposals for pharmacy benefits manager for Public
Employees' Benefit and Insurance Program.
Health insurance mandates.
Health insurance mandates.
Section 71.
Effective Date.
(1)
Except as provided in Subsections (2) and (3), this bill takes effect January 1, 2028.
(2)
The actions affecting the following sections take effect on January 1, 2027:
(a)
Section 26B-2-201(Effective 01/01/27);
(b)
Section 26B-2-206(Effective 01/01/27);
(c)
Section 26B-3-104.1(Effective 01/01/27); and
(d)
Section 26B-3-908(Effective 01/01/27).
(3)
The actions affecting the following sections take effect on July 1, 2027:
(a)
Section 26B-4-701
;
(b)
Section 26C-1-101(Effective 07/01/27);
(c)
Section 26C-1-102(Effective 07/01/27);
(d)
Section 26C-1-103(Effective 07/01/27);
(e)
Section 26C-1-104(Effective 07/01/27);
(f)
Section 26C-2-101(Effective 07/01/27);
(g)
Section 26C-2-102(Effective 07/01/27);
(h)
Section 26C-2-103(Effective 07/01/27);
(i)
Section 26C-2-104(Effective 07/01/27);
(j)
Section 26C-2-105(Effective 07/01/27)(Repealed 07/01/27);
(k)
Section 26C-2-106(Effective 07/01/27);
(l)
Section 26C-2-107(Effective 07/01/27);
(m)
Section 26C-2-108(Effective 07/01/27);
(n)
Section 26C-2-109(Effective 07/01/27);
(o)
Section 26C-2-710(Effective 07/01/27);
(p)
Section 26C-2-111(Effective 07/01/27);
(q)
Section 26C-2-112(Effective 07/01/27); and
(r)
Section 26C-3-101(Effective 07/01/27).
3-4-26 4:57 PM