Effective 5/12/2020 26-18-402. Medicaid Restricted Account. (1) There is created a restricted account in the General Fund known as the Medicaid Restricted Account. (2) (a) Except as provided in Subsection (3), the following shall be deposited into the Medicaid Restricted Account: (i) any general funds appropriated to the department for the state plan for medical […]
Effective 5/4/2022 26-18-402.5. Nonlapsing Medicaid funds. (1) Notwithstanding Subsection 26-18-402(3), for fiscal years 2019-20, 2020-21, and 2021-22, the funds described in Subsections 26-18-402(3)(a) and 26-18-402(2)(a)(ii) are nonlapsing. (2) This section supersedes any conflicting provisions of Utah law. Amended by Chapter 40, 2022 General Session
26-18-403. Medicaid waiver for independent foster care adolescents. (1) For purposes of this section, an “independent foster care adolescent” includes any individual who reached 18 years of age while in the custody of the Division of Child and Family Services, or the Department of Human Services if the Division of Child and Family Services was […]
Effective 5/12/2020 26-18-405. Waivers to maximize replacement of fee-for-service delivery model — Cost of mandated program changes. (1) The department shall develop a waiver program in the Medicaid program to replace the fee-for-service delivery model with one or more risk-based delivery models. (2) The waiver program shall: (a) restructure the program’s provider payment provisions to […]
Effective 7/1/2022 26-18-405.5. Base budget appropriations for Medicaid accountable care organizations and behavioral health plans — Forecast of behavioral health services cost. (1) As used in this section: (a) “ACO” means an accountable care organization that contracts with the state’s Medicaid program for: (i) physical health services; or (ii) integrated physical and behavioral health services. […]
Effective 7/1/2020 26-18-408. Incentives to appropriately use emergency department services. (1) (a) This section applies to the Medicaid program and to the Utah Children’s Health Insurance Program created in Chapter 40, Utah Children’s Health Insurance Act. (b) As used in this section: (i) “Managed care organization” means a comprehensive full risk managed care delivery system […]
Effective 5/13/2014 26-18-409. Long-term care insurance partnership. (1) As used in this section: (a) “Qualified long-term care insurance contract” is as defined in 26 U.S.C. Sec. 7702B(b). (b) “Qualified long-term care insurance partnership” is as defined in 42 U.S.C. Sec. 1396p(b)(1)(C)(iii). (c) “State plan amendment” means an amendment to the state Medicaid plan drafted by […]
Effective 5/4/2022 26-18-410. Medicaid waiver for children with disabilities and complex medical needs. (1) As used in this section: (a) “Additional eligibility criteria” means the additional eligibility criteria set by the department under Subsection (4)(e). (b) “Complex medical condition” means a physical condition of an individual that: (i) results in severe functional limitations for the […]
Effective 1/1/2023 26-18-411. Health coverage improvement program — Eligibility — Annual report — Expansion of eligibility for adults with dependent children. (1) As used in this section: (a) “Adult in the expansion population” means an individual who: (i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and (ii) is not otherwise eligible for Medicaid as a […]
Effective 5/12/2020 26-18-413. Medicaid waiver for delivery of adult dental services. (1) (a) Before June 30, 2016, the department shall ask CMS to grant waivers from federal statutory and regulatory law necessary for the Medicaid program to provide dental services in the manner described in Subsection (2)(a). (b) Before June 30, 2018, the department shall […]
Effective 5/9/2017 26-18-414. Medicaid long-term support services housing coordinator. (1) There is created within the Medicaid program a full-time-equivalent position of Medicaid long-term support services housing coordinator. (2) The coordinator shall help Medicaid recipients receive long-term support services in a home or other community-based setting rather than in a nursing home or other institutional setting […]
Effective 5/14/2019 26-18-415. Medicaid waiver expansion. (1) As used in this section: (a) “Federal poverty level” means the same as that term is defined in Section 26-18-411. (b) “Medicaid waiver expansion” means an expansion of the Medicaid program in accordance with this section. (2) (a) Before January 1, 2019, the department shall apply to CMS […]
Effective 5/12/2020 26-18-416. Primary Care Network enhancement waiver program. (1) As used in this section: (a) “Enhancement waiver program” means the Primary Care Network enhancement waiver program described in this section. (b) “Federal poverty level” means the poverty guidelines established by the secretary of the United States Department of Health and Human Services under 42 […]
Effective 7/1/2020 26-18-417. Limited family planning services for low-income individuals. (1) As used in this section: (a) (i) “Family planning services” means family planning services that are provided under the state Medicaid program, including: (A) sexual health education and family planning counseling; and (B) other medical diagnosis, treatment, or preventative care routinely provided as part […]
Affected by 63I-1-226 on 7/1/2023 Effective 5/12/2020 26-18-418. Medicaid waiver for mental health crisis lines and mobile crisis outreach teams. (1) As used in this section: (a) “Local mental health crisis line” means the same as that term is defined in Section 62A-15-1301. (b) “Mental health crisis” means: (i) a mental health condition that manifests […]
Effective 5/14/2019 26-18-419. Medicaid waiver for coverage of mental health services in schools. (1) As used in this section, “local education agency” means: (a) a school district; (b) a charter school; or (c) the Utah Schools for the Deaf and the Blind. (2) In consultation with the Department of Human Services and the State Board […]
Affected by 63I-2-226 on 7/1/2030 Effective 5/12/2020 26-18-420. 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 enrollee” means an individual who: (i) is enrolled in […]
Effective 5/5/2021 26-18-420.1. Medicaid waiver for fertility preservation services. (1) As used in this section: (a) “Iatrogenic infertility” means an impairment of fertility or reproductive functioning caused by surgery, chemotherapy, radiation, or other medical treatment. (b) “Physician” means an individual licensed to practice under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, […]
Effective 5/12/2020 26-18-421. Medicaid waiver for coverage of qualified inmates leaving prison or jail. (1) As used in this section: (a) “Correctional facility” means: (i) a county jail; (ii) the Department of Corrections, created in Section 64-13-2; or (iii) a prison, penitentiary, or other institution operated by or under contract with the Department of Corrections […]
Effective 5/12/2020 26-18-422. Medicaid waiver for inpatient care in an institution for mental diseases. (1) As used in this section, “institution for mental diseases” means the same as that term is defined in 42 C.F.R. Sec. 435.1010. (2) Before August 1, 2020, the division shall apply for a Medicaid waiver or a state plan amendment […]
