Bill > HB0566

This bill aims to increase transparency within Utah's Medicaid program by requiring managed care organizations (MCOs), which are entities that contract with Medicaid to provide healthcare services, to publicly report detailed financial and service utilization data. Specifically, by December 31, 2026, the state will launch a public online dashboard that will be updated quarterly with information broken down by MCO, including the number of services rendered, total spending on medical claims and other expenditures, spending on specific types of benefits (like mandatory and optional Medicaid benefits, including "value-add benefits" which are extra services beyond standard coverage), emergency room usage, spending on prescription drugs, and the number of enrollees with no claims filed. MCOs must also submit all data and reports they provide to the federal Centers for Medicare & Medicaid Services (CMS) to the state within 30 days of submission, with the state then making this information publicly available after redacting protected health information. Furthermore, MCOs and their subcontractors are required to quarterly identify and document "improper payments," which are defined broadly to include payments made in error, for services not rendered, to ineligible providers, or due to conflicts of interest, and must conduct a root cause analysis, repay any identified improper payments, and develop corrective action plans. The state will publish these reports on improper payments, unless doing so would hinder an ongoing investigation. The bill also establishes penalties for MCOs that fail to comply, including potential termination from the Medicaid program and a five-year ban on re-contracting, and requires MCOs to certify the accuracy of their submitted data.

Health and Social Services, Transportation and Infrastructure

https://le.utah.gov/~2026/bills/static/HB0566.html