Medical Benefits Recovery

Utah Code tit. 26B, ch. 26B-3, pt. 26B-3-P10

in effect

Utah Code § 26B-3-1001 Definitions.

26B-3-1001. Definitions. As used in this part: (1) "Annuity" shall have the same meaning as provided in Section 31A-1-301. (2) "Care facility" means: (a) a nursing facility; (b) an intermediate care facility for an individual with an intellectual disability; or (c) any other medical institution. (3) "Claim" means: (a) a request or demand for payment; or (b) a cause of action for money or damages arising under any law. (4) "Employee welfare benefit plan" means a medical insurance plan developed by an employer under 29 U.S.C. Sec. 1001, et seq., the Employee Retirement Income Security Act of 1974 as amended. (5) "Health insurance entity" means: (a) an insurer; (b) a person who administers, manages, provides, offers, sells, carries, or underwrites health insurance, as defined in Section 31A-1-301; (c) a self-insured plan; (d) a group health plan, as defined in Subsection 607(1) of the federal Employee Retirement Income Security Act of 1974; (e) a service benefit plan; (f) a managed care organization; (g) a pharmacy benefit manager; (h) an employee welfare benefit plan; or (i) a person who is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. (6) "Inpatient" means an individual who is a patient and a resident of a care facility. (7) "Insurer" includes: (a) a group health plan as defined in Subsection 607(1) of the federal Employee Retirement Income Security Act of 1974; (b) a health maintenance organization; and (c) any entity offering a health service benefit plan. (8) "Medical assistance" means: (a) all funds expended for the benefit of a recipient under this chapter or Titles XVIII and XIX, federal Social Security Act; and (b) any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department. (9) "Office of Recovery Services" means the Office of Recovery Services within the department. (10) "Provider" means a person or entity who provides services to a recipient. (11) "Recipient" means: (a) an individual who has applied for or received medical assistance from the state; (b) the guardian, conservator, or other personal representative of an individual under Subsection (11)(a) if the individual is a minor or an incapacitated person; or (c) the estate and survivors of an individual under Subsection (11)(a), if the individual is deceased. (12) "Recovery estate" means, regarding a deceased recipient: (a) all real and personal property or other assets included within a decedent's estate as defined in Section 75-1-201; (b) the decedent's augmented estate as defined in Section 75-2-203; and (c) that part of other real or personal property in which the decedent had a legal interest at the time of death including assets conveyed to a survivor, heir, or assign of the decedent through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement. (13) "State plan" means the state Medicaid program as enacted in accordance with Title XIX, federal Social Security Act. (14) "TEFRA lien" means a lien, authorized under the Tax Equity and Fiscal Responsibility Act of 1982, against the real property of an individual prior to the individual's death, as described in 42 U.S.C. Sec. 1396p. (15) "Third party" includes: (a) an individual, institution, corporation, public or private agency, trust, estate, insurance carrier, employee welfare benefit plan, health maintenance organization, health service organization, preferred provider organization, governmental program such as Medicare, CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by department rule; and (b) a spouse or a parent who: (i) may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order; or (ii) has been ordered to maintain health, dental, or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order. (16) "Trust" shall have the same meaning as provided in Section 75-1-201. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1002 Program established by department -- Promulgation of rules.

26B-3-1002. Program established by department -- Promulgation of rules. (1) The department shall establish and maintain a program for the recoupment of medical assistance. (2) The department may promulgate rules to implement the purposes of this part. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1003 Assignment of rights to benefits.

26B-3-1003. Assignment of rights to benefits. (1) (a) Except as provided in Subsection 26B-3-1009(1), to the extent that medical assistance is actually provided to a recipient, all benefits for medical services or payments from a third-party otherwise payable to or on behalf of a recipient are assigned by operation of law to the department if the department provides, or becomes obligated to provide, medical assistance, regardless of who made application for the benefits on behalf of the recipient. (b) The assignment: (i) authorizes the department to submit its claim to the third-party and authorizes payment of benefits directly to the department; and (ii) is effective for all medical assistance. (2) The department may recover the assigned benefits or payments in accordance with Section 26B-3-1009 and as otherwise provided by law. (3) (a) The assignment of benefits includes medical support and third-party payments ordered, decreed, or adjudged by any court of this state or any other state or territory of the United States. (b) The assignment is not in lieu of, and does not supersede or alter any other court order, decree, or judgment. (4) When an assignment takes effect, the recipient is entitled to receive medical assistance, and the benefits paid to the department are a reimbursement to the department. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1004 Health insurance entity -- Duties related to state claims for Medicaid payment or recovery.

26B-3-1004. Health insurance entity -- Duties related to state claims for Medicaid payment or recovery. (1) As a condition of doing business in the state, a health insurance entity shall: (a) with respect to an individual who is eligible for, or is provided, medical assistance under the state plan, upon the request of the department, provide information to determine: (i) during what period the individual, or the spouse or dependent of the individual, may be or may have been, covered by the health insurance entity; and (ii) the nature of the coverage that is or was provided by the health insurance entity described in Subsection (1)(a), including the name, address, and identifying number of the plan; (b) accept the state's right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan; (c) respond within 60 days to any inquiry by the department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided; (d) not deny a claim submitted by the department solely on the basis of the date of submission of the claim, the type or format of the claim form, or failure to present proper documentation at the point-of-sale that is the basis for the claim, if: (i) the claim is submitted no later than three years after the day on which the item or service is furnished; and (ii) any action by the department to enforce the rights of the state with respect to the claim is commenced no later than six years after the day on which the claim is submitted; and (e) not deny a claim submitted by the department or the department's contractor for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer's rules. (2) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the department shall make rules that: (a) construe and implement Subsection (1)(e); and (b) encourage health care providers to seek prior authorization when necessary from a health insurance entity that is the primary payer before seeking third-party liability through Medicaid. Amended by Chapter 284, 2024 General Session

Utah Code § 26B-3-1005 Insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance -- Exemptions.

26B-3-1005. Insurance policies not to deny or reduce benefits of individuals eligible for state medical assistance -- Exemptions. (1) A policy of accident or sickness insurance may not contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance from the state. (2) An association, corporation, or organization may not deliver, issue for delivery, or renew any subscriber's contract which contains any provisions denying or reducing benefits because services are rendered to a subscriber or dependent who is eligible for or receiving medical assistance from the state. (3) An association, corporation, business, or organization authorized to do business in this state and which provides or pays for any health care benefits may not deny or reduce benefits because services are rendered to a beneficiary who is eligible for or receiving medical assistance from the state. (4) Notwithstanding Subsection (1), (2), or (3), the Utah State Public Employees' Health Program, administered by the Utah State Retirement Board, is not required to reimburse any agency of state government for custodial care which the agency provides, through its staff or facilities, to members of the Utah State Public Employees' Health Program. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1006 Availability of insurance policy.

26B-3-1006. Availability of insurance policy. If the third party does not pay the department's claim or lien within 30 days from the date the claim or lien is received, the third party shall: (1) provide a written explanation if the claim is denied; (2) specifically describe and request any additional information from the department that is necessary to process the claim; and (3) provide the department or its agent a copy of any relevant or applicable insurance or benefit policy. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1007 Employee benefit plans.

26B-3-1007. Employee benefit plans. As allowed pursuant to 29 U.S.C. Sec. 1144, an employee benefit plan may not include any provision that has the effect of limiting or excluding coverage or payment for any health care for an individual who would otherwise be covered or entitled to benefits or services under the terms of the employee benefit plan based on the fact that the individual is eligible for or is provided services under the state plan. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1008 Statute of limitations -- Survival of right of action -- Insurance policy not to limit time allowed for recovery.

26B-3-1008. Statute of limitations -- Survival of right of action -- Insurance policy not to limit time allowed for recovery. (1) (a) Subject to Subsection (6), action commenced by the department under this part against a health insurance entity shall be commenced within: (i) subject to Subsection (7), six years after the day on which the department submits the claim for recovery or payment for the health care item or service upon which the action is based; or (ii) six months after the date of the last payment for medical assistance, whichever is later. (b) An action against any other third party, the recipient, or anyone to whom the proceeds are payable shall be commenced within: (i) four years after the date of the injury or onset of the illness; or (ii) six months after the date of the last payment for medical assistance, whichever is later. (2) The death of the recipient does not abate any right of action established by this part. (3) (a) No insurance policy issued or renewed after June 1, 1981, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than 24 months from the date the provider furnishes services or goods to the recipient. (b) No insurance policy issued or renewed after April 30, 2007, may contain any provision that limits the time in which the department may submit its claim to recover medical assistance benefits to a period of less than that described in Subsection (1)(a). (4) The provisions of this section do not apply to Section 26B-3-1013 or Sections 26B-3-1015 through 26B-3-1023. (5) The provisions of this section supersede any other sections regarding the time limit in which an action shall be commenced, including Section 75B-2-509. (6) (a) Subsection (1)(a) extends the statute of limitations on a cause of action described in Subsection (1)(a) that was not time-barred on or before April 30, 2007. (b) Subsection (1)(a) does not revive a cause of action that was time-barred on or before April 30, 2007. (7) An action described in Subsection (1)(a) may not be commenced if the claim for recovery or payment described in Subsection (1)(a)(i) is submitted later than three years after the day on which the health care item or service upon which the claim is based was provided. Amended by Chapter 310, 2025 General Session

Utah Code § 26B-3-1009 Recovery of medical assistance from third party -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action protected.

26B-3-1009. Recovery of medical assistance from third party -- Lien -- Notice -- Action -- Compromise or waiver -- Recipient's right to action protected. (1) (a) Except as provided in Subsection (1)(c), if the department provides or becomes obligated to provide medical assistance to a recipient that a third-party is obligated to pay for, the department may recover the medical assistance directly from the third-party. (b) (i) A claim under Subsection (1)(a) or Section 26B-3-1003 to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third-party. (ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the proceeds, except claims for attorney fees and costs authorized under Subsection 26B-3-1011(2)(c)(ii). (c) (i) The department may not recover medical assistance under Subsection (1)(a) if: (A) the third-party is obligated to pay the recipient for an injury to the recipient's child that occurred while the child was in the physical custody of the child's foster parent; (B) the child's injury is a physical or mental impairment that requires ongoing medical attention, or limits activities of daily living, for at least one year; (C) the third-party's payment to the recipient is placed in a trust, annuity, financial account, or other financial instrument for the benefit of the child; and (D) the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state. (ii) The department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under Subsection (1)(c)(i). (2) (a) The department shall mail or deliver written notice of the department's claim or lien to the third-party at the third-party's principal place of business or last-known address. (b) The notice shall include: (i) the recipient's name; (ii) the approximate date of illness or injury; (iii) a general description of the type of illness or injury; and (iv) if applicable, the general location where the injury is alleged to have occurred. (3) The department may commence an action on the department's claim or lien in the department's name, but the claim or lien is not enforceable as to a third-party unless: (a) the third-party receives written notice of the department's claim or lien before the third-party settles with the recipient; or (b) the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance. (4) The department may: (a) waive a claim or lien against a third party in whole or in part; or (b) compromise, settle, or release a claim or lien. (5) An action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department's action. (6) Except as provided in Subsection (1)(c), the department's claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust, annuity, financial account, or other financial instrument. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1010 Action by department -- Notice to recipient.

26B-3-1010. Action by department -- Notice to recipient. (1) (a) Within 30 days after commencing an action under Subsection 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action by: (i) personal service or certified mail to the last known address of the person receiving the notice; or (ii) if no last-known address is available, by publishing a notice: (A) once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides; and (B) in accordance with Section 45-1-101 for three weeks. (b) Proof of service shall be filed in the action. (c) The recipient may intervene in the department's action at any time before trial. (2) The notice required by Subsection (1) shall name the court in which the action is commenced and advise the recipient of: (a) the right to intervene in the proceeding; (b) the right to obtain a private attorney; and (c) the department's right to recover medical assistance directly from the third party. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1011 Notice of claim by recipient -- Department response -- Conditions for proceeding -- Collection agreements.

26B-3-1011. Notice of claim by recipient -- Department response -- Conditions for proceeding -- Collection agreements. (1) (a) A recipient may not file a claim, commence an action, or settle, compromise, release, or waive a claim against a third party for recovery of medical costs for an injury, disease, or disability for which the department has provided or has become obligated to provide medical assistance, without the department's written consent as provided in Subsection (2)(b) or (4). (b) For purposes of Subsection (1)(a), consent may be obtained if: (i) a recipient who files a claim, or commences an action against a third party notifies the department in accordance with Subsection (1)(d) within 10 days of the recipient making the claim or commencing an action; or (ii) an attorney, who has been retained by the recipient to file a claim, or commence an action against a third party, notifies the department in accordance with Subsection (1)(d) of the recipient's claim: (A) within 30 days after being retained by the recipient for that purpose; or (B) within 30 days from the date the attorney either knew or should have known that the recipient received medical assistance from the department. (c) Service of the notice of claim to the department shall be made by certified mail, personal service, or by e-mail in accordance with Rule 5 of the Utah Rules of Civil Procedure, to the director of the Office of Recovery Services. (d) The notice of claim shall include the following information: (i) the name of the recipient; (ii) the recipient's Social Security number; (iii) the recipient's date of birth; (iv) the name of the recipient's attorney if applicable; (v) the name or names of individuals or entities against whom the recipient is making the claim, if known; (vi) the name of the third party's insurance carrier, if known; (vii) the date of the incident giving rise to the claim; and (viii) a short statement identifying the nature of the recipient's claim. (2) (a) Within 30 days of receipt of the notice of the claim required in Subsection (1), the department shall acknowledge receipt of the notice of the claim to the recipient or the recipient's attorney and shall notify the recipient or the recipient's attorney in writing of the following: (i) if the department has a claim or lien pursuant to Section 26B-3-1009 or has become obligated to provide medical assistance; and (ii) whether the department is denying or granting written consent in accordance with Subsection (1)(a). (b) The department shall provide the recipient's attorney the opportunity to enter into a collection agreement with the department, with the recipient's consent, unless: (i) the department, prior to the receipt of the notice of the recipient's claim pursuant to Subsection (1), filed a written claim with the third party, the third party agreed to make payment to the department before the date the department received notice of the recipient's claim, and the agreement is documented in the department's record; or (ii) there has been a failure by the recipient's attorney to comply with any provision of this section by: (A) failing to comply with the notice provisions of this section; (B) failing or refusing to enter into a collection agreement; (C) failing to comply with the terms of a collection agreement with the department; or (D) failing to disburse funds owed to the state in accordance with this section. (c) (i) The collection agreement shall be: (A) consistent with this section and the attorney's obligation to represent the recipient and represent the state's claim; and (B) state the terms under which the interests of the department may be represented in an action commenced by the recipient. (ii) If the recipient's attorney enters into a written collection agreement with the department, or includes the department's claim in the recipient's claim or action pursuant to Subsection (4), the department shall pay attorney fees at the rate of 33.3% of the department's total recovery and shall pay a proportionate share of the litigation expenses directly related to the action. (d) The department is not required to enter into a collection agreement with the recipient's attorney for collection of personal injury protection under Subsection 31A-22-302(2). (3) (a) If the department receives notice pursuant to Subsection (1), and notifies the recipient and the recipient's attorney that the department will not enter into a collection agreement with the recipient's attorney, the recipient may proceed with the recipient's claim or action against the third party if the recipient excludes from the claim: (i) any medical expenses paid by the department; or (ii) any medical costs for which the department is obligated to provide medical assistance. (b) When a recipient proceeds with a claim under Subsection (3)(a), the recipient shall provide written notice to the third party of the exclusion of the department's claim for expenses under Subsection (3)(a)(i) or (ii). (4) If the department receives notice pursuant to Subsection (1), and does not respond within 30 days to the recipient or the recipient's attorney, the recipient or the recipient's attorney: (a) may proceed with the recipient's claim or action against the third party; (b) may include the state's claim in the recipient's claim or action; and (c) may not negotiate, compromise, settle, or waive the department's claim without the department's consent. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1012 Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance.

26B-3-1012. Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance. (1) The department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance. (2) (a) If the recipient proceeds without complying with the provisions of Section 26B-3-1011, the department is not bound by any decision, judgment, agreement, settlement, or compromise rendered or made on the claim or in the action. (b) The department: (i) may recover in full from the recipient, or any party to which the proceeds were made payable, all medical assistance that the department has provided; and (ii) retains its right to commence an independent action against the third party, subject to Subsection 26B-3-1009(3). (3) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than five business days after receipt. (4) (a) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days after the funds are placed in the attorney's trust account. (b) The date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient's attorney. (c) The department's consent to another date for remittance may not be unreasonably withheld. (d) If the funds are received by the recipient's attorney, no disbursements shall be made to the recipient or the recipient's attorney until the department's claim has been paid. (5) A recipient or recipient's attorney who knowingly and intentionally fails to comply with this section is liable to the department for: (a) the amount of the department's claim or lien pursuant to Subsection (1); (b) a penalty equal to 10% of the amount of the department's claim; and (c) attorney fees and litigation expenses related to recovering the department's claim. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1013 Estate and trust recovery.

26B-3-1013. Estate and trust recovery. (1) (a) Except as provided in Subsection (1)(b), upon a recipient's death, the department may recover from the recipient's recovery estate and any trust, in which the recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit of the recipient when the recipient was 55 years old or older. (b) The department may not make an adjustment or a recovery under Subsection (1)(a): (i) while the deceased recipient's spouse is still living; or (ii) if the deceased recipient has a surviving child who is: (A) under 21 years old; or (B) blind or disabled, as defined in the state plan. (2) (a) The amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient's recovery estate or any trust when the recipient is the grantor and a beneficiary. (b) The lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in Section 75-3-805. (3) (a) For a lien described in Subsection (2), the department shall provide notice in accordance with Section 38-12-102. (b) Before final distribution, the department shall perfect the lien as follows: (i) for an estate, by presenting the lien to the estate's personal representative in accordance with Section 75-3-804; and (ii) for a trust, by presenting the lien to the trustee in accordance with Section 75B-2-510. (c) The department may file an amended lien before the entry of the final order to close the estate or trust. (4) Claims against a deceased recipient's inter vivos trust shall be presented in accordance with Sections 75B-2-509 and 75B-2-510. (5) Any trust provision that denies recovery for medical assistance is void at the time of its making. (6) Nothing in this section affects the right of the department to recover Medicaid assistance before a recipient's death under Section 26B-3-1003 or 26B-3-1014. (7) A lien imposed under this section is of indefinite duration. Amended by Chapter 310, 2025 General Session

Utah Code § 26B-3-1014 Recovery from recipient of incorrectly provided medical assistance.

26B-3-1014. Recovery from recipient of incorrectly provided medical assistance. The department may: (1) recover medical assistance incorrectly provided, whether due to administrative or factual error or fraud, from the recipient or the recipient's recovery estate; and (2) pursuant to a judgment, impose a lien against real property of the recipient. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1015 TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions.

26B-3-1015. TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions. (1) Except as provided in Subsections (2) and (3), the department may impose a TEFRA lien on the real property of an individual for the amount of medical assistance provided for, or to, the individual while the individual is an inpatient in a care facility, if: (a) the individual is an inpatient in a care facility; (b) the individual is required, as a condition of receiving services under the state plan, to spend for costs of medical care all but a minimal amount of the individual's income required for personal needs; and (c) the department determines that the individual cannot reasonably be expected to: (i) be discharged from the care facility; and (ii) return to the individual's home. (2) The department may not impose a lien on the home of an individual described in Subsection (1), if any of the following individuals are lawfully residing in the home: (a) the spouse of the individual; (b) a child of the individual, if the child is: (i) under 21 years old; or (ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or (c) a sibling of the individual, if the sibling: (i) has an equity interest in the home; and (ii) resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility. (3) The department may not impose a TEFRA lien on the real property of an individual, unless: (a) the individual has been an inpatient in a care facility for the 180-day period immediately preceding the day on which the lien is imposed; (b) the department serves: (i) a preliminary notice of intent to impose a TEFRA lien relating to the real property, in accordance with Section 26B-3-1017; and (ii) a final notice of intent to impose a TEFRA lien relating to the real property, in accordance with Section 26B-3-1018; and (c) (i) the individual does not file a timely request for review of the department's decision under Title 63G, Chapter 4, Administrative Procedures Act; or (ii) the department's decision is upheld upon final review or appeal under Title 63G, Chapter 4, Administrative Procedures Act. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1016 Presumption of permanency.

26B-3-1016. Presumption of permanency. There is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual's home, if the individual has been an inpatient in a care facility for a period of at least 180 consecutive days. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1017 Preliminary notice of intent to impose a TEFRA lien.

26B-3-1017. Preliminary notice of intent to impose a TEFRA lien. (1) Prior to imposing a TEFRA lien on real property, the department shall serve a preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection 26B-3-1015(1), who owns the property. (2) The preliminary notice of intent shall: (a) be served in person, or by certified mail, on the individual described in Subsection 26B-3-1015(1), and, if the department is aware that the individual has a legally authorized representative, on the representative; (b) include a statement indicating that, according to the department's records, the individual: (i) meets the criteria described in Subsections 26B-3-1015(1)(a) and (b); (ii) has been an inpatient in a care facility for a period of at least 180 days immediately preceding the day on which the department provides the notice to the individual; and (iii) is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual's home; (c) indicate that the department intends to impose a TEFRA lien on real property belonging to the individual; (d) describe the real property that the TEFRA lien will apply to; (e) describe the current amount of, and purpose of, the TEFRA lien; (f) indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance; (g) indicate that the individual may seek to prevent the TEFRA lien from being imposed on the real property by providing documentation to the department that: (i) establishes that the individual does not meet the criteria described in Subsection 26B-3-1015(1)(a) or (b); (ii) establishes that the individual has not been an inpatient in a care facility for a period of at least 180 days; (iii) rebuts the presumption described in Section 26B-3-1016; or (iv) establishes that the real property is exempt from imposition of a TEFRA lien under Subsection 26B-3-1015(2); (h) indicate that if the owner fails to provide the documentation described in Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is served, the department will issue a final notice of intent to impose a TEFRA lien on the real property and will proceed to impose the lien; (i) identify the type of documentation that the owner may provide to comply with Subsection (2)(g); (j) describe the circumstances under which a TEFRA lien is required to be released; and (k) describe the circumstances under which the department may seek to recover the lien. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1018 Final notice of intent to impose a TEFRA lien.

26B-3-1018. Final notice of intent to impose a TEFRA lien. (1) The department may issue a final notice of intent to impose a TEFRA lien on real property if: (a) a preliminary notice of intent relating to the property is served in accordance with Section 26B-3-1017; (b) it is at least 30 days after the day on which the preliminary notice of intent was served; and (c) the department has not received documentation or other evidence that adequately establishes that a TEFRA lien may not be imposed on the real property. (2) The final notice of intent to impose a TEFRA lien on real property shall: (a) be served in person, or by certified mail, on the individual described in Subsection 26B-3-1015(1), who owns the property, and, if the department is aware that the individual has a legally authorized representative, on the representative; (b) indicate that the department has complied with the requirements for filing the final notice of intent under Subsection (1); (c) include a statement indicating that, according to the department's records, the individual: (i) meets the criteria described in Subsections 26B-3-1015(1)(a) and (b); (ii) has been an inpatient in a care facility for a period of at least 180 days immediately preceding the day on which the department provides the notice to the individual; and (iii) is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual's home; (d) indicate that the department intends to impose a TEFRA lien on real property belonging to the individual; (e) describe the real property that the TEFRA lien will apply to; (f) describe the current amount of, and purpose of, the TEFRA lien; (g) indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance; (h) describe the circumstances under which a TEFRA lien is required to be released; (i) describe the circumstances under which the department may seek to recover the lien; (j) describe the right of the individual to challenge the decision of the department in an adjudicative proceeding; and (k) indicate that failure by the individual to successfully challenge the decision of the department will result in the TEFRA lien being imposed. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1019 Review of department decision.

26B-3-1019. Review of department decision. An individual who has been served with a final notice of intent to impose a TEFRA lien under Section 26B-3-1018 may seek agency or judicial review of that decision under Title 63G, Chapter 4, Administrative Procedures Act. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1020 Dissolution and removal of TEFRA lien.

26B-3-1020. Dissolution and removal of TEFRA lien. (1) A TEFRA lien shall dissolve and be removed by the department if the individual described in Subsection 26B-3-1015(1): (a) (i) is discharged from the care facility; and (ii) returns to the individual's home; or (b) provides sufficient documentation to the department that: (i) rebuts the presumption described in Section 26B-3-1016; or (ii) any of the following individuals are lawfully residing in the individual's home: (A) the spouse of the individual; (B) a child of the individual, if the child is under 21 years old or blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or (C) a sibling of the individual, if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility. (2) An individual described in Subsection 26B-3-1015(1)(a) may, at any time after the department has imposed a lien under Sections 26B-3-1015 through 26B-3-1023, file a request for the department to remove the lien. (3) A request filed under Subsection (2) shall be considered and reviewed pursuant to Title 63G, Chapter 4, Administrative Procedures Act. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1021 Expenditures included in lien -- Other proceedings.

26B-3-1021. Expenditures included in lien -- Other proceedings. (1) A TEFRA lien imposed on real property under Sections 26B-3-1015 through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility, regardless of when the lien is imposed or filed on the property. (2) Nothing in Sections 26B-3-1015 through 26B-3-1023 affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1022 Contract with another government agency.

26B-3-1022. Contract with another government agency. If the department contracts with another government agency to recover funds paid for medical assistance under this part, that government agency shall be the sole agency that determines whether to impose or remove a TEFRA lien under Sections 26B-3-1015 through 26B-3-1023. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1023 Precedence of the Tax Equity and Fiscal Responsibility Act of 1982.

26B-3-1023. Precedence of the Tax Equity and Fiscal Responsibility Act of 1982. If any provision of Sections 26B-3-1015 through 26B-3-1023 conflict with the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for imposing a lien against the property of an individual prior to the individual's death, under 42 U.S.C. Sec. 1396p, the provisions of the Tax Equity and Fiscal Responsibility Act of 1982 take precedence and shall be complied with by the department. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1024 Legal recognition of electronic claims records.

26B-3-1024. Legal recognition of electronic claims records. Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act: (1) a claim submitted to the department for payment may not be denied legal effect, enforceability, or admissibility as evidence in any court in any civil action because it is in electronic form; and (2) a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department's claim. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1025 Direct payment to the department by third party.

26B-3-1025. Direct payment to the department by third party. (1) Any third party required to make payment to the department pursuant to this part shall make the payment directly to the department or its designee. (2) The department may negotiate a payment or payment instrument it receives in connection with Subsection (1) without the cosignature or other participation of the recipient or any other party. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1026 Attorney general or county attorney to represent department.

26B-3-1026. Attorney general or county attorney to represent department. The attorney general or a county attorney shall represent the department in any action commenced under this part. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1027 Department's right to attorney fees and costs.

26B-3-1027. Department's right to attorney fees and costs. In any action brought by the department under this part in which it prevails, the department shall recover along with the principal sum and interest, a reasonable attorney fee and costs incurred. Renumbered and Amended by Chapter 306, 2023 General Session

Utah Code § 26B-3-1028 Application of provisions contrary to federal law prohibited.

26B-3-1028. Application of provisions contrary to federal law prohibited. In no event shall any provision contained in this part be applied contrary to existing federal law. Renumbered and Amended by Chapter 306, 2023 General Session

Source: Utah Office of Legislative Research and General Counsel (le.utah.gov)URL: https://le.utah.gov/xcode/Title26B/Chapter3/26B-3-P10.html?v=C26B-3-P10_2023050320230503Fetched: 10/26/2026