26B-3-1202. Medicaid managed care quality data -- Dashboard-- Reporting requirements -- Rulemaking authority.

974 words·~4 min read·/ut/title-26b/chapter-3/26b-3-1202

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Effective 5/6/2026

(a)By December 31, 2026, the division shall establish and maintain a dashboard to report the data described in this Subsection

(1)that is:

(i)online on the division's website;

(ii)easily accessible to the public through a link posted in a conspicuous place on the division's website;

(iii)organized by managed care plan;

(iv)searchable;

(v)machine readable; and

(vi)able to be downloaded or printed.

(b)For each managed care plan, the division shall publish and quarterly update on the dashboard described in Subsection (1)(a) , the following data:

(i)the total count of services rendered, by billing code type, Medicaid provider type, and care setting;

(ii)total spending on medical claims, non-claims expenditures, and non-benefit services by managed care organization;

(iii)total spending on pass through payments and state directed payments by facility;

(iv)total spending:

(A)by billing code type;

(B)by Medicaid provider type, including public and private Medicaid providers, and care setting type;

(C)on mandatory Medicaid benefits; and

(D)on optional Medicaid benefits, including value add benefits;

(v)total number and share of enrollees receiving care in an emergency room;

(vi)total claims and spending on services delivered in an emergency room;

(vii)total spending on services delivered by a subcontractor or managed care organization's related party, by service type;

(viii)total spending on prescription drugs by active ingredient; and

(ix)total number and share of enrollees for whom no claims were filed.

(c)When publishing the data described in Subsection (1)(b)(iv) , the division shall identify whether the source of funding for the reported spending is federal or state funds.

(d)The division may use existing databases or other tools to fulfill the requirements of this Subsection

(1).

(e)By December 31, 2026, the dashboard shall include the data described in Subsection (1)(b) from January 1, 2023, through September 30, 2026.

(a)A managed care organization shall submit to the division complete copies of all data, reports, and disclosures the managed care organization submits to CMS related to the managed care organization's participation in the Medicaid program no later than 30 days after the day on which the managed care organization submits the data, report, or disclosure to CMS.

(b)No later than 30 days after the day on which the division receives a submission described in Subsection (2)(a) , the division shall post the submission on the division's website:

(i)in a format that is searchable and machine readable; and

(ii)through a link that is easily accessible to the public and posted in a conspicuous place on the division's website.

(c)The division shall redact protected health information from a submission before posting the submission on the division's website as described in Subsection (2)(b) .

(3)A managed care organization shall certify in writing that the data, reports, and disclosures the managed care organization submits to the division under Subsection

(2)are accurate and complete.

(4)The department shall require that each managed care contract includes a provision that requires a managed care plan to comply with this section and rules the department makes under this section, subject to sanctions provided in accordance with Section 26B-3-108 .

(5)If the division, under rules made by the department in accordance with Section 26B-3-108 , or the federal government, sanctions a managed care organization with termination from the Medicaid program, the managed care organization is not eligible to enter into a new contract with the department:

(a)until five years after the date on which the managed care organization was terminated; and

(b)unless the managed care organization submits to the department a written explanation of action the managed care organization has taken to ensure the managed care organization's compliance with this section.

(a)The division shall annually publish a report that includes a summary of, and managed care organization-specific measures of, managed care organizations' financial performance and service utilization.

(b)The division shall annually submit the report described in Subsection (6)(a) , on or before November 1 each year, to the Health and Human Services Interim Committee and the Social Services Appropriations Subcommittee.

(a)The division shall make publicly available on the division's website:

(i)the data described in Subsection

(1)in the dashboard described in Subsection (1)(a) ;

(ii)medical loss ratio audited reports; and

(iii)the report described in Subsection

(6).

(b)The division shall ensure that data that is published as described in this section, including financial data and data described in Subsection

(1), is deidentified.

(a)Unless otherwise provided by applicable state or federal law, a submission a managed care organization submits to the division in accordance with this section is a public record under Title 63G, Chapter 2, Government Records Access and Management Act.

(b)Except as provided in Subsection (8)(c) , a risk contractor, subcontractor, or an affiliated person of the risk contractor or subcontractor, may not make a claim of business confidentiality under Section 63G-2-309 for any data, information, report, or disclosure submitted to the division under this section.

(c)Subsection (8)(b) does not apply to commercial information or nonindividual financial information described in Subsection 63G-2-305(2) .

(d)If a person described in Subsection (8)(b) makes a claim of business confidentiality in accordance with Subsection 63G-2-305(2) as described in Subsection (8)(c) , the division shall redact the information that is subject to the claim of business confidentiality before publishing, posting, or otherwise making the submission public.

(9)Nothing in this section shall be construed to alter or preempt the requirements for protecting health information under HIPAA.

(10)The department shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section.

Enacted by Chapter 163 , 2026 General Session