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[Utah Code Table of Contents]
[TITLE 26. Table of Contents]
26-40-101 Title.
This chapter is known as the "Utah Children's Health Insurance
Act."
1998
26-40-102 Definitions.
As used in this chapter:
(1) "Child" means a person who is under 19 years of age.
(2) "Eligible child" means a child who qualifies for enrollment in the program as provided in Section 26-40-105 .
(3) "Enrollee" means any child enrolled in the program.
(4) "Plan" means the department's plan submitted to the United States Department of Health and Human Services pursuant to 42 U.S.C. Sec. 1397ff.
(5) "Program" means the Utah Children's Health Insurance
Program created by this chapter.
2000
26-40-103 Creation and administration of the Utah Children's Health Insurance Program.
(1) There is created the Utah Children's Health Insurance Program to be administered by the department in accordance with the provisions of:
(a) this chapter; and
(b) the State Children's Health Insurance Program, 42 U.S.C. Sec. 1397aa et seq.
(2) The department shall:
(a) prepare and submit the state's children's health insurance plan before May 1, 1998, and any amendments to the federal Department of Health and Human Services in accordance with 42 U.S.C. Sec. 1397ff; and
(b) make rules in accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act regarding:
(i) eligibility requirements consistent with Subsection 26-18-3 (6);
(ii) program benefits;
(iii) the level of coverage for each program benefit;
(iv) cost-sharing requirements for enrollees, which may not:
(A) exceed the guidelines set forth in 42 U.S.C. Sec. 1397ee; or
(B) impose deductible, copayment, or coinsurance requirements on an enrollee for well-child, well-baby, and immunizations; and
(v) the administration of the program.
2003
26-40-104 Utah Children's Health Insurance Program Advisory Council.
(1) There is created a Utah Children's Health Insurance Program Advisory Council consisting of at least eight and no more than eleven members appointed by the executive director of the department. The term of each appointment shall be three years. The appointments shall be staggered at one-year intervals to ensure continuity of the advisory council.
(2) The advisory council shall meet at least quarterly.
(3) The membership of the advisory council shall include at least one representative from each of the following groups:
(a) child health care providers;
(b) parents and guardians of children enrolled in the program;
(c) ethnic populations other than American Indians;
(d) American Indians;
(e) the Utah Association of Health Care Providers;
(f) health and accident and health insurance providers; and
(g) the general public.
(4) The advisory council shall advise the department on:
(a) benefits design;
(b) eligibility criteria;
(c) outreach;
(d) evaluation; and
(e) special strategies for under-served populations.
(5) (a) (i) Members who are not government employees may not receive compensation or benefits for their services, but may receive per diem and expenses incurred in the performance of the member's official duties at the rates established by the Division of Finance under Sections 63A-3-106 and 63A-3-107 .
(ii) Members may decline to receive per diem and expenses for their service.
(b) (i) State government officer and employee members who do not receive salary, per diem, or expenses from their agency for their service may receive per diem and expenses incurred in the performance of their official duties from the council at the rates established by the Division of Finance under Sections 63A-3-106 and 63A-3-107 .
(ii) State government officer and employee members may
decline to receive per diem and expenses for their service.
2001
26-40-105 Eligibility.
(1) To be eligible to enroll in the program, a child must:
(a) be a bona fide Utah resident;
(b) be a citizen or legal resident of the United States;
(c) be under 19 years of age;
(d) not have access to or coverage under other health insurance, including any coverage available through a parent or legal guardian's employer;
(e) be ineligible for Medicaid benefits;
(f) reside in a household whose gross family income, as defined by rule, is at or below 200% of the federal poverty level; and
(g) not be an inmate of a public institution or a patient in an institution for mental diseases.
(2) A child may not be determined to be ineligible to enroll in the program based on diagnosis or pre-existing condition.
(3) The department shall determine eligibility and send notification of the decision within 30 days after receiving the application for coverage. If the department cannot reach a decision because the applicant fails to take a required action or there is an administrative or other emergency beyond the department's control, the department shall:
(a) document the reason for the delay in the applicant's case record; and
(b) inform the applicant of the status of the application
and time frame for completion.
1998
26-40-106 Program benefits.
At a minimum, program benefits shall include:
(1) hospital services;
(2) physician services;
(3) laboratory services;
(4) prescription drugs;
(5) mental health services;
(6) basic dental services;
(7) preventive care including:
(a) routine physical examinations;
(b) immunizations;
(c) basic vision services; and
(d) basic hearing services;
(8) limited home health and durable medical equipment services; and
(9) hospice care.
1998
26-40-107 Limitation of benefits.
Abortion is not a covered benefit, except as provided
in 42 U.S.C. Sec. 1397ee.
1998
26-40-108 Funding.
(1) The program shall be funded by federal matching funds received under, together with state matching funds required by, 42 U.S.C. Sec. 1397ee.
(2) Program expenditures in the following categories may not exceed 10% in the aggregate of all federal payments pursuant to 42 U.S.C. Sec. 1397ee:
(a) other forms of child health assistance for children with gross family incomes below 200% of the federal poverty level;
(b) other health services initiatives to improve low-income children's health;
(c) outreach program expenditures; and
(d) administrative costs.
1998
26-40-109 Evaluation.
(1) The department shall develop performance measures and annually evaluate the program's performance.
(2) The department shall report annually on its evaluation
to the Health and Human Services Interim Committee of the
Legislature before November 1.
2001
26-40-110 Managed care - Contracting for services.
(1) Services provided to enrollees under the program shall be delivered in a managed care system if services are available within 30 paved road miles of where the enrollee lives or resides. Otherwise, the program may provide services to enrollees through fee for service plans.
(2) Before awarding a contract to a managed care system or fee for service plan to provide services under Subsection (1) or determining that no bid or proposal received in response to such a request is acceptable, the executive director shall report that information to and seek recommendations from the Health Advisory Council created in Section 26-1-7.5 .
(3) If after seeking the recommendation of the Health Advisory Council under Subsection (2), the executive director determines that no bid or proposal received in response to such a request is acceptable or if no bid or proposal has been received in response to such a request, the department may contract with the Group Insurance Division within the Utah State Retirement Office to provide services under Subsection (1).
(4) Title 63, Chapter 56, Utah Procurement Code, shall
apply to this section.
2001
