Bill > HB0566

This bill aims to increase transparency within Utah's Medicaid program by requiring the state division to create and maintain an online dashboard by December 31, 2026, that will publicly report detailed financial and service utilization data for each managed care plan, including spending on medical claims, non-benefit services, prescription drugs, and emergency room visits, as well as the number of enrollees receiving care in emergency rooms and those for whom no claims were filed. Managed care organizations (MCOs), which are entities that contract with Medicaid to provide health care, must also submit copies of all data and reports they provide to the Centers for Medicare & Medicaid Services (CMS) to the state division within 30 days of submission, with the division then making this information publicly accessible after redacting protected health information. Furthermore, MCOs and their subcontractors must quarterly identify and document any "improper payments" – which are defined broadly to include payments made in error, for services not rendered, to deceased individuals, or in violation of contracts or laws – conduct a root cause analysis for these issues, repay any owed funds to Medicaid, and develop corrective action plans, with reports on these findings to be published online unless they interfere with an ongoing investigation. The bill also mandates that MCO contracts include provisions for compliance with these transparency requirements, subject to sanctions, and establishes a five-year ban from new contracts for MCOs terminated from the Medicaid program due to sanctions, unless they can demonstrate corrective actions. Finally, the bill requires the division to annually publish a report summarizing MCO financial performance and service utilization, which will be submitted to legislative committees.

Health and Social Services, Transportation and Infrastructure

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