Utah 2025 Regular Session

Utah House Bill HB0495 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~Enrolled Copy~~ H.B. 495
	1	+	02-26 10:10 H.B. 495
2	2		1
3	3		Health Care Amendments
4	4		2025 GENERAL SESSION
5	5		STATE OF UTAH
6	6		Chief Sponsor: James A. Dunnigan
7		-	Senate Sponsor: ~~Evan J. Vickers~~
	7	+	Senate Sponsor:
8	8		2
9	9
10	10		3
11	11		LONG TITLE
12	12		4
13	13		General Description:
14	14		5
15	15		This bill amends provisions related to health care practices.
16	16		6
17	17		Highlighted Provisions:
18	18		7
19	19		This bill:
20	20		8
21	21		▸ amends provisions regarding the use of credit card payments to health care providers;
22	22		9
23	23		▸ amends provisions related to dental claims practices; and
24	24		10
25	25		▸ allows dentists to dispense medications under certain circumstances.
26	26		11
27	27		Money Appropriated in this Bill:
28	28		12
29	29		None
30	30		13
31	31		Other Special Clauses:
32	32		14
33	33		None
34	34		15
35	35		Utah Code Sections Affected:
36	36		16
37	37		AMENDS:
38	38		17
39	39		31A-26-301.6, as last amended by Laws of Utah 2024, Chapter 120
40	40		18
41	41		31A-26-301.7, as enacted by Laws of Utah 2021, Chapter 288
42	42		19
43	43		58-88-201, as last amended by Laws of Utah 2023, Chapter 329
44	44		20
45	45		58-88-202, as last amended by Laws of Utah 2024, Chapter 210
46	46		21
47	47
48	48		22
49	49		Be it enacted by the Legislature of the state of Utah:
50	50		23
51	51		Section 1. Section 31A-26-301.6 is amended to read:
52	52		24
53	53		31A-26-301.6 . Health care claims practices.
54	54		25
55	55		(1) As used in this section:
56	56		26
57	57		(a) "Health care provider" means a person licensed to provide health care under:
58	58		27
59	59		(i) Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection; or
60	60		28
61		-	(ii) Title 58, Occupations and Professions. ~~H.B. 495 Enrolled Copy~~
	61	+	(ii) Title 58, Occupations and Professions.
62	62		29
63	63		(b) "Insurer" means an admitted or authorized insurer, as defined in Section 31A-1-301,
64	64		30
65	65		and includes:
	66	+	H.B. 495 H.B. 495 02-26 10:10
66	67		31
67	68		(i) a health maintenance organization; and
68	69		32
69	70		(ii) a third party administrator that is subject to this title, provided that nothing in this
70	71		33
71	72		section may be construed as requiring a third party administrator to use its own
72	73		34
73	74		funds to pay claims that have not been funded by the entity for which the third
74	75		35
75	76		party administrator is paying claims.
76	77		36
77	78		(c) "Provider" means a health care provider to whom an insurer is obligated to pay
78	79		37
79	80		directly in connection with a claim by virtue of:
80	81		38
81	82		(i) an agreement between the insurer and the provider;
82	83		39
83	84		(ii) an accident and health insurance policy or contract of the insurer; or
84	85		40
85	86		(iii) state or federal law.
86	87		41
87	88		(2) An insurer shall timely pay every valid insurance claim submitted by a provider in
88	89		42
89	90		accordance with this section.
90	91		43
91	92		(3)(a) Except as provided in Subsection (4), within 30 days of the day on which the
92	93		44
93	94		insurer receives a written claim, an insurer shall:
94	95		45
95	96		(i) pay the claim; or
96	97		46
97	98		(ii) deny the claim and provide a written explanation for the denial.
98	99		47
99	100		(b)(i) Subject to Subsection (3)(b)(ii), the time period described in Subsection (3)(a)
100	101		48
101	102		may be extended by 15 days if the insurer:
102	103		49
103	104		(A) determines that the extension is necessary due to matters beyond the control
104	105		50
105	106		of the insurer; and
106	107		51
107	108		(B) before the end of the 30-day period described in Subsection (3)(a), notifies the
108	109		52
109	110		provider and insured in writing of:
110	111		53
111	112		(I) the circumstances requiring the extension of time; and
112	113		54
113	114		(II) the date by which the insurer expects to pay the claim or deny the claim
114	115		55
115	116		with a written explanation for the denial.
116	117		56
117	118		(ii) If an extension is necessary due to a failure of the provider or insured to submit
118	119		57
119	120		the information necessary to decide the claim:
120	121		58
121	122		(A) the notice of extension required by this Subsection (3)(b) shall specifically
122	123		59
123	124		describe the required information; and
124	125		60
125	126		(B) the insurer shall give the provider or insured at least 45 days from the day on
126	127		61
127	128		which the provider or insured receives the notice before the insurer denies the
128	129		62
129	130		claim for failure to provide the information requested in Subsection
130		-	- 2 - Enrolled Copy H.B. 495
131	131		63
132	132		(3)(b)(ii)(A).
133	133		64
134	134		(4)(a) In the case of a claim for income replacement benefits, within 45 days of the day
	135	+	- 2 - 02-26 10:10 H.B. 495
135	136		65
136	137		on which the insurer receives a written claim, an insurer shall:
137	138		66
138	139		(i) pay the claim; or
139	140		67
140	141		(ii) deny the claim and provide a written explanation of the denial.
141	142		68
142	143		(b) Subject to Subsections (4)(d) and (e), the time period described in Subsection (4)(a)
143	144		69
144	145		may be extended for 30 days if the insurer:
145	146		70
146	147		(i) determines that the extension is necessary due to matters beyond the control of the
147	148		71
148	149		insurer; and
149	150		72
150	151		(ii) before the expiration of the 45-day period described in Subsection (4)(a), notifies
151	152		73
152	153		the insured of:
153	154		74
154	155		(A) the circumstances requiring the extension of time; and
155	156		75
156	157		(B) the date by which the insurer expects to pay the claim or deny the claim with a
157	158		76
158	159		written explanation for the denial.
159	160		77
160	161		(c) Subject to Subsections (4)(d) and (e), the time period for complying with Subsection
161	162		78
162	163		(4)(a) may be extended for up to an additional 30 days from the day on which the
163	164		79
164	165		30-day extension period provided in Subsection (4)(b) ends if before the day on
165	166		80
166	167		which the 30-day extension period ends, the insurer:
167	168		81
168	169		(i) determines that due to matters beyond the control of the insurer a decision cannot
169	170		82
170	171		be rendered within the 30-day extension period; and
171	172		83
172	173		(ii) notifies the insured of:
173	174		84
174	175		(A) the circumstances requiring the extension; and
175	176		85
176	177		(B) the date as of which the insurer expects to pay the claim or deny the claim
177	178		86
178	179		with a written explanation for the denial.
179	180		87
180	181		(d) A notice of extension under this Subsection (4) shall specifically explain:
181	182		88
182	183		(i) the standards on which entitlement to a benefit is based; and
183	184		89
184	185		(ii) the unresolved issues that prevent a decision on the claim.
185	186		90
186	187		(e) If an extension allowed by Subsection (4)(b) or (c) is necessary due to a failure of the
187	188		91
188	189		insured to submit the information necessary to decide the claim:
189	190		92
190	191		(i) the notice of extension required by Subsection (4)(b) or (c) shall specifically
191	192		93
192	193		describe the necessary information; and
193	194		94
194	195		(ii) the insurer shall give the insured at least 45 days from the day on which the
195	196		95
196	197		insured receives the notice before the insurer denies the claim for failure to
197	198		96
198	199		provide the information requested in Subsection (4)(b) or (c).
199		-	- 3 - H.B. 495 Enrolled Copy
200	200		97
201	201		(5) If a period of time is extended as permitted under Subsection (3)(b), (4)(b), or (4)(c),
202	202		98
203	203		due to an insured or provider failing to submit information necessary to decide a claim,
	204	+	- 3 - H.B. 495 02-26 10:10
204	205		99
205	206		the period for making the benefit determination shall be tolled from the date on which
206	207		100
207	208		the notification of the extension is sent to the insured or provider until the date on which
208	209		101
209	210		the insured or provider responds to the request for additional information.
210	211		102
211	212		(6) An insurer shall pay all sums to the provider or insured that the insurer is obligated to
212	213		103
213	214		pay on the claim, and provide a written explanation of the insurer's decision regarding
214	215		104
215	216		any part of the claim that is denied within 20 days of receiving the information requested
216	217		105
217	218		under Subsection (3)(b), (4)(b), or (4)(c).
218	219		106
219	220		(7)(a) Whenever an insurer makes a payment to a provider on any part of a claim under
220	221		107
221	222		this section, the insurer shall also send to the insured an explanation of benefits paid.
222	223		108
223	224		(b) Whenever an insurer denies any part of a claim under this section, the insurer shall
224	225		109
225	226		also send to the insured:
226	227		110
227	228		(i) a written explanation of the part of the claim that was denied; and
228	229		111
229	230		(ii) notice of the adverse benefit determination review process established under
230	231		112
231	232		Section 31A-22-629.
232	233		113
233	234		(c) This Subsection (7) does not apply to a person receiving benefits under the state
234	235		114
235	236		Medicaid program as defined in Section 26B-3-101, unless required by the
236	237		115
237	238		Department of Health and Human Services or federal law.
238	239		116
239	240		(8)(a) A late fee shall be imposed on:
240	241		117
241	242		(i) an insurer that fails to timely pay a claim in accordance with this section; and
242	243		118
243	244		(ii) a provider that fails to timely provide information on a claim in accordance with
244	245		119
245	246		this section.
246	247		120
247	248		(b) The late fee described in Subsection (8)(a) shall be determined by multiplying
248	249		121
249	250		together:
250	251		122
251	252		(i) the total amount of the claim the insurer is obliged to pay;
252	253		123
253	254		(ii) the total number of days the response or the payment is late; and
254	255		124
255	256		(iii) 0.033% daily interest rate.
256	257		125
257	258		(c) Any late fee paid or collected under this Subsection (8) shall be separately identified
258	259		126
259	260		on the documentation used by the insurer to pay the claim.
260	261		127
261	262		(d) For purposes of this Subsection (8), "late fee" does not include an amount that is less
262	263		128
263	264		than $1.
264	265		129
265	266		(9) Each insurer shall establish a review process to resolve claims-related disputes between
266	267		130
267	268		the insurer and providers.
268		-	- 4 - Enrolled Copy H.B. 495
269	269		131
270	270		(10) An insurer or person representing an insurer may not engage in any unfair claim
271	271		132
272	272		settlement practice with respect to a provider. Unfair claim settlement practices include:
	273	+	- 4 - 02-26 10:10 H.B. 495
273	274		133
274	275		(a) knowingly misrepresenting a material fact or the contents of an insurance policy in
275	276		134
276	277		connection with a claim;
277	278		135
278	279		(b) failing to acknowledge and substantively respond within 15 days to any written
279	280		136
280	281		communication from a provider relating to a pending claim;
281	282		137
282	283		(c) denying or threatening to deny the payment of a claim for any reason that is not
283	284		138
284	285		clearly described in the insured's policy;
285	286		139
286	287		(d) failing to maintain a payment process sufficient to comply with this section;
287	288		140
288	289		(e) failing to maintain claims documentation sufficient to demonstrate compliance with
289	290		141
290	291		this section;
291	292		142
292	293		(f) failing, upon request, to give to the provider written information regarding the
293	294		143
294	295		specific rate and terms under which the provider will be paid for health care services;
295	296		144
296	297		(g) failing to timely pay a valid claim in accordance with this section as a means of
297	298		145
298	299		influencing, intimidating, retaliating, or gaining an advantage over the provider with
299	300		146
300	301		respect to an unrelated claim, an undisputed part of a pending claim, or some other
301	302		147
302	303		aspect of the contractual relationship;
303	304		148
304	305		(h) failing to pay the sum when required and as required under Subsection (8) when a
305	306		149
306	307		violation has occurred;
307	308		150
308	309		(i) threatening to retaliate or actual retaliation against a provider for the provider
309	310		151
310	311		applying this section;
311	312		152
312	313		(j) any material violation of this section; and
313	314		153
314	315		(k) any other unfair claim settlement practice established in rule or law.
315	316		154
316	317		(11)(a) The provisions of this section shall apply to each contract between an insurer and
317	318		155
318	319		a provider for the duration of the contract.
319	320		156
320	321		(b) Notwithstanding Subsection (11)(a), this section may not be the basis for a bad faith
321	322		157
322	323		insurance claim.
323	324		158
324	325		(c) Nothing in Subsection (11)(a) may be construed as limiting the ability of an insurer
325	326		159
326	327		and a provider from including provisions in their contract that are more stringent than
327	328		160
328	329		the provisions of this section.
329	330		161
330	331		(12)(a) Pursuant to Chapter 2, Part 2, Duties and Powers of Commissioner, the
331	332		162
332	333		commissioner may conduct examinations to determine an insurer's level of
333	334		163
334	335		compliance with this section and impose sanctions for each violation.
335	336		164
336	337		(b) The commissioner may adopt rules only as necessary to implement this section.
337		-	- 5 - H.B. 495 Enrolled Copy
338	338		165
339	339		(c) The commissioner may establish rules to facilitate the exchange of electronic
340	340		166
341	341		confirmations when claims-related information has been received.
	342	+	- 5 - H.B. 495 02-26 10:10
342	343		167
343	344		(d) Notwithstanding Subsection (12)(b), the commissioner may not adopt rules
344	345		168
345	346		regarding the review process required by Subsection (9).
346	347		169
347	348		(13) Nothing in this section may be construed as limiting the collection rights of a provider
348	349		170
349	350		under Section 31A-26-301.5.
350	351		171
351	352		(14) Nothing in this section may be construed as limiting the ability of an insurer to:
352	353		172
353	354		(a) recover any amount improperly paid to a provider or an insured:
354	355		173
355	356		(i) in accordance with Section 31A-31-103 or any other provision of state or federal
356	357		174
357	358		law;
358	359		175
359	360		(ii) within 24 months of the amount improperly paid for a coordination of benefits
360	361		176
361	362		error;
362	363		177
363	364		(iii) within 12 months of the amount improperly paid for any other reason not
364	365		178
365	366		identified in Subsection (14)(a)(i) or (ii); or
366	367		179
367	368		(iv) within 36 months of the amount improperly paid when the improper payment
368	369		180
369	370		was due to a recovery by Medicaid, Medicare, the Children's Health Insurance
370	371		181
371	372		Program, or any other state or federal health care program;
372	373		182
373	374		(b) take any action against a provider that is permitted under the terms of the provider
374	375		183
375	376		contract and not prohibited by this section;
376	377		184
377	378		(c) report the provider to a state or federal agency with regulatory authority over the
378	379		185
379	380		provider for unprofessional, unlawful, or fraudulent conduct; or
380	381		186
381	382		(d) enter into a mutual agreement with a provider to resolve alleged violations of this
382	383		187
383	384		section through mediation or binding arbitration.
384	385		188
385	386		(15) A provider may only seek recovery from the insurer for an amount improperly paid by
386	387		189
387	388		the insurer within the same time frames as Subsections (14)(a) and (b).
388	389		190
389	390		(16)(a) An insurer may offer the remittance of payment through a credit card or other
390	391		191
391	392		similar arrangement.
392	393		192
393	394		(b)(i) A provider may elect not to receive remittance through a credit card or other
394	395		193
395	396		similar arrangement.
396	397		194
397	398		(ii) An insurer:
398	399		195
399	400		(A) shall permit a provider's election described in Subsection (16)(b)(i) to apply to
400	401		196
401	402		the provider's entire practice; [and]
402	403		197
403	404		(B) may not require a provider's election described in Subsection (16)(b)(i) to be
404	405		198
405	406		made on a patient-by-patient basis[.] ; and
406		-	- 6 - Enrolled Copy H.B. 495
407	407		199
408	408		(C) shall allow a provider to opt out of all credit card or other similar
409	409		200
410	410		arrangements for every plan offered by the insurer through a single opt out
	411	+	- 6 - 02-26 10:10 H.B. 495
411	412		201
412	413		process.
413	414		202
414	415		(iii) If a provider elects not to receive remittance through a credit card or other
415	416		203
416	417		similar arrangement, that decision remains in effect until:
417	418		204
418	419		(A) the provider affirmatively elects to receive remittance through credit card or
419	420		205
420	421		similar arrangement; or
421	422		206
422	423		(B) a new contract is issued.
423	424		207
424	425		(c) An insurer may not require a provider or insured to accept remittance through a
425	426		208
426	427		credit card or other similar arrangement.
427	428		209
428		-	(d) An insurer shall allow a tangible check as a form of acceptable payment.
	429	+	(d) An insurer shall Ĥ→ [accept ] allow ←Ĥ a tangible check as a form
	430	+	209a
	431	+	of acceptable payment.
429	432		210
430	433		Section 2. Section 31A-26-301.7 is amended to read:
431	434		211
432	435		31A-26-301.7 . Dental claim transparency and practices.
433	436		212
434	437		(1) As used in this section:
435	438		213
436	439		(a) "Bundling" means the practice of combining distinct dental procedures into one
437	440		214
438	441		procedure for billing purposes.
439	442		215
440	443		(b) "Dental plan" means the same as that term is defined in Section 31A-22-646.
441	444		216
442	445		(c) "Downcoding" means the adjustment of a claim submitted to a dental plan to a less
443	446		217
444	447		complex or lower cost procedure code.
445	448		218
446	449		(d) "Covered services" means the same as that term is defined in Section 31A-22-646.
447	450		219
448	451		(e) "Material change" means a change to:
449	452		220
450	453		(i) a dental plan's rules, guidelines, policies, or procedures concerning payment for
451	454		221
452	455		dental services;
453	456		222
454	457		(ii) the general policies of the dental plan that affect a reimbursement paid to
455	458		223
456	459		providers; or
457	460		224
458	461		(iii) the manner by which a dental plan adjudicates and pays a claim for services.
459	462		225
460	463		(2) An insurer that contracts or renews a contract with a dental provider shall:
461	464		226
462	465		(a) make a copy of the insurer's current dental plan policies available online; and
463	466		227
464	467		(b) if requested by a provider, send a copy of the policies to the provider through mail or
465	468		228
466	469		electronic mail.
467	470		229
468	471		(3) Dental policies described in Subsection (2) shall include:
469	472		230
470	473		(a) a summary of all material changes made to a dental plan since the policies were last
471	474		231
472	475		updated;
473	476		232
474	477		(b) the downcoding and bundling policies that the insurer reasonably expects to be
475		-	- 7 - H.B. 495 Enrolled Copy
476	478		233
477	479		applied to the dental provider or provider's services as a matter of policy; and
	480	+	- 7 - H.B. 495 02-26 10:10
478	481		234
479	482		(c) a description of the dental plan's utilization review procedures, including:
480	483		235
481	484		(i) a procedure for an enrollee of the dental plan to obtain review of an adverse
482	485		236
483	486		determination in accordance with Section 31A-22-629; and
484	487		237
485	488		(ii) a statement of a provider's rights and responsibilities regarding the procedures
486	489		238
487	490		described in Subsection (3)(c)(i).
488	491		239
489	492		(4) An insurer may not maintain a dental plan that:
490	493		240
491	494		(a) based on the provider's contracted fee for covered services, uses downcoding in a
492	495		241
493		-	manner that prevents a dental provider from collecting the contracted fee for the
	496	+	manner that prevents a dental provider from collecting the Ĥ→ contracted ←Ĥ fee for
	497	+	241a
	498	+	the actual service
494	499		242
495		-	~~actual service~~ performed from either the plan or the patient;[ or]
	500	+	performed from either the plan or the patient; [or]
496	501		243
497	502		(b) uses bundling in a manner where a procedure code is labeled as nonbillable to the
498	503		244
499	504		patient unless, under generally accepted practice standards, the procedure code is for
500	505		245
501	506		a procedure that may be provided in conjunction with another procedure[.] ;
502	507		246
503		-	(c) does not allow a dental provider to seek payment of the contracted fee for a covered
	508	+	(c) does not allow a dental provider to Ĥ→ [bill] seek payment of the
	509	+	246a
	510	+	contracted fee for a covered service from ←Ĥ the patient Ĥ→ [for a service] ←Ĥ
	511	+	246b
	512	+	when the insurer
504	513		247
505		-	service from the patient when the insurer denies payment for the service, unless
	514	+	denies Ĥ→ [the claim] payment ←Ĥ for the service, unless under
	515	+	247a
	516	+	generally accepted practice standards,
506	517		248
507		-	~~under generally accepted practice standards,~~ the service performed should not be
	518	+	the service performed should not be billed; or
508	519		249
509		-	billed; or
	520	+	(d) Ĥ→ beginning January 1, 2026, ←Ĥ automatically recoups an overpayment
	521	+	249a
	522	+	unless:
510	523		250
511		-	(d) ~~beginning January 1,~~ ~~2026, automatically recoups an overpayment unless:~~
	524	+	(i) the recoupment occurs more than 60 days from the day the insurer sends a notice
512	525		251
513		-	~~(i)~~ the ~~recoupment occurs more than 60 days from the day the insurer sends a notice~~
	526	+	of the overpayment; or
514	527		252
515		-	of the ~~overpayment; or~~
	528	+	(ii) the dental provider affirmatively elects to have recoupment occur earlier than 60
516	529		253
517		-	~~(ii)~~ the ~~dental provider affirmatively elects to have recoupment occur earlier than 60~~
	530	+	days from the day the insurer sends a notice of the overpayment.
518	531		254
519		-	~~days from the day the~~ insurer ~~sends~~ a ~~notice of the overpayment.~~
	532	+	(5)(a) An insurer shall ensure that an explanation of benefits for a dental plan includes
520	533		255
521		-	~~(5)(a) An insurer shall ensure that an explanation of benefits~~ for ~~a dental plan includes~~
	534	+	the reason for any downcoding or bundling result.
522	535		256
523		-	the ~~reason for any downcoding or bundling result.~~
	536	+	(b) A dental provider who receives an overpayment from a dental plan shall return the
524	537		257
525		-	~~(b) A dental provider who receives an~~ overpayment ~~from a~~ dental plan ~~shall return the~~
	538	+	amount of the overpayment through check or other means to the dental plan within
526	539		258
527		-	~~amount~~ of the overpayment ~~through check or other means to the dental plan within~~
	540	+	60 days from the day the insurer sends a notice of the overpayment.
528	541		259
529		-	~~60 days from the day the insurer sends~~ a ~~notice~~ of ~~the overpayment.~~
	542	+	(c) A dental provider shall make reasonable efforts to inform patients of services that
530	543		260
531		-	~~(c) A~~ dental provider ~~shall make reasonable efforts to inform patients of services that~~
	544	+	may not be covered by the patient's dental plan if the dental provider will perform a
532	545		261
533		-	may not be covered ~~by the patient's dental plan if the dental provider will perform a~~
	546	+	service that may not be covered.
534	547		262
535		-	service that may not be covered.
	548	+	Section 3. Section 58-88-201 is amended to read:
	549	+	- 8 - 02-26 10:10 H.B. 495
536	550		263
537		-	~~Section 3. Section~~ 58-88-201 ~~is amended to read:~~
	551	+	58-88-201 . Definitions.
538	552		264
539		-	~~58-88-201 . Definitions.~~
	553	+	As used in this part:
540	554		265
541		-	~~As used in this part:~~
	555	+	(1)(a) "Dispense" means the delivery by a prescriber of a prescription drug or device to a
542	556		266
543		-	(1)(a) "Dispense" means the delivery by a prescriber of a prescription drug or device to a
544		-	- 8 - Enrolled Copy H.B. 495
	557	+	patient, including the packaging, labeling, and security necessary to prepare and
545	558		267
546		-	~~patient, including~~ the ~~packaging, labeling,~~ ~~and security necessary~~ to ~~prepare and~~
	559	+	safeguard the drug or device for supplying to a patient.
547	560		268
548		-	~~safeguard the drug or device for supplying to a patient.~~
	561	+	(b) "Dispense" does not include:
549	562		269
550		-	(b) ~~"Dispense" does not include:~~
	563	+	(i) prescribing or administering a drug or device; or
551	564		270
552		-	(i) ~~prescribing or administering~~ a ~~drug or device;~~ or
	565	+	(ii) delivering to a patient a sample packaged for individual use by a licensed
553	566		271
554		-	~~(ii) delivering to~~ a ~~patient a sample packaged for individual use by a licensed~~
	567	+	manufacturer or re-packager of a drug or device.
555	568		272
556		-	~~manufacturer or re-packager~~ ~~of a drug or device.~~
	569	+	(2) "Dispensing practitioner" means an individual who:
557	570		273
558		-	(2) ~~"Dispensing practitioner"~~ ~~means an individual who~~:
	571	+	(a) is currently licensed as:
559	572		274
560		-	(a) ~~is currently licensed as:~~
	573	+	(i) a physician and surgeon under Chapter 67, Utah Medical Practice Act;
561	574		275
562		-	(i) a physician and surgeon under Chapter 67, Utah ~~Medical Practice Act;~~
	575	+	(ii) an osteopathic physician and surgeon under Chapter 68, Utah Osteopathic
563	576		276
564		-	~~(ii) an osteopathic physician and surgeon under Chapter 68, Utah Osteopathic~~
	577	+	Medical Practice Act;
565	578		277
566		-	~~Medical~~ Practice ~~Act~~;
	579	+	(iii) an advanced practice registered nurse under Subsection 58-31b-301(2)(d); [or]
567	580		278
568		-	(~~iii~~) ~~an advanced practice registered nurse~~ under ~~Subsection 58-31b-301(2)(d)~~;[ or]
	581	+	(iv) a physician assistant under Chapter 70a, Utah Physician Assistant Act; or
569	582		279
570		-	(iv) a ~~physician assistant~~ under Chapter ~~70a~~, ~~Utah Physician Assistant~~ Act; or
	583	+	(v) a dentist under Chapter 69, Dentist and Dental Hygienist Practice Act;
571	584		280
572		-	(v) ~~a dentist under Chapter 69,~~ ~~Dentist~~ and ~~Dental Hygienist Practice Act;~~
	585	+	(b) is authorized by state law to prescribe and administer drugs in the course of
573	586		281
574		-	~~(b) is authorized by state law to prescribe~~ and ~~administer drugs in the course of~~
	587	+	professional practice; and
575	588		282
576		-	~~professional~~ practice~~; and~~
	589	+	(c) practices at a licensed dispensing practice.
577	590		283
578		-	(c) ~~practices at a licensed dispensing practice~~.
	591	+	(3) "Drug" means the same as that term is defined in Section 58-17b-102.
579	592		284
580		-	(3) "~~Drug~~" means ~~the same as that term is defined in Section 58-17b-102.~~
	593	+	(4) "Health care practice" means:
581	594		285
582		-	(4) "Health care ~~practice" means:~~
	595	+	(a) a health care facility as defined in Section 26B-2-201; or
583	596		286
584		-	(a) ~~a health care facility as defined in Section 26B-2-201;~~ or
	597	+	(b) the offices of one or more private prescribers, whether for individual or group
585	598		287
586		-	~~(b) the offices of one or more private prescribers, whether for individual or group~~
	599	+	practice.
587	600		288
588		-	practice.
	601	+	(5) "Licensed dispensing practice" means a health care practice that is licensed as a
589	602		289
590		-	~~(5) "Licensed~~ dispensing practice~~" means a health care practice that is licensed as a~~
	603	+	dispensing practice under Section 58-88-202.
591	604		290
592		-	~~dispensing practice under~~ Section 58-88-202.
	605	+	Section 4. Section 58-88-202 is amended to read:
593	606		291
594		-	~~Section 4. Section~~ 58-88-202 ~~is amended to read:~~
	607	+	58-88-202 . Dispensing practice -- Drugs that may be dispensed -- Limitations
595	608		292
596		-	~~58-88-202~~ . ~~Dispensing practice -- Drugs that may be dispensed -- Limitations~~
	609	+	and exceptions.
597	610		293
598		-	~~and exceptions.~~
	611	+	(1) Notwithstanding Section 58-17b-302, a dispensing practitioner may dispense a drug at a
599	612		294
600		-	~~(1) Notwithstanding Section 58-17b-302, a~~ dispensing ~~practitioner may dispense a~~ drug ~~at a~~
	613	+	licensed dispensing practice if the drug is:
601	614		295
602		-	~~licensed dispensing practice if the drug is~~:
	615	+	(a) packaged in a fixed quantity per package by:
603	616		296
604		-	(a) packaged in a fixed quantity per package by:
	617	+	(i) the drug manufacturer;
	618	+	- 9 - H.B. 495 02-26 10:10
605	619		297
606		-	(i) ~~the drug manufacturer~~;
	620	+	(ii) a pharmaceutical wholesaler or distributor; or
607	621		298
608		-	(ii) a ~~pharmaceutical wholesaler or distributor~~; or
	622	+	(iii) a pharmacy licensed under Chapter 17b, Pharmacy Practice Act;
609	623		299
610		-	(~~iii~~) ~~a pharmacy licensed under Chapter 17b, Pharmacy Practice Act;~~
	624	+	(b) dispensed:
611	625		300
612		-	(b) dispensed:
613		-	- 9 - H.B. 495 Enrolled Copy
	626	+	(i) at a licensed dispensing practice at which the dispensing practitioner regularly
614	627		301
615		-	~~(i) at a licensed dispensing practice at which the dispensing practitioner regularly~~
	628	+	practices; and
616	629		302
617		-	~~practices; and~~
	630	+	(ii) under a prescription issued by the dispensing practitioner to the dispensing
618	631		303
619		-	~~(ii) under a prescription issued by the dispensing practitioner to the dispensing~~
	632	+	practitioner's patient;
620	633		304
621		-	~~practitioner's patient;~~
	634	+	(c) except as provided in Subsection (6), for a condition that is not expected to last
622	635		305
623		-	~~(c) except as provided in Subsection (6), for a condition that is not expected to last~~
	636	+	longer than 30 days; and
624	637		306
625		-	~~longer than 30 days;~~ ~~and~~
	638	+	(d) for a condition for which the patient has been evaluated by the dispensing
626	639		307
627		-	~~(d) for a condition for~~ which the ~~patient has been evaluated by~~ the ~~dispensing~~
	640	+	practitioner on the same day on which the dispensing practitioner dispenses the drug.
628	641		308
629		-	~~practitioner on the same day on which the~~ dispensing practitioner ~~dispenses the drug.~~
	642	+	(2) A dispensing practitioner may not dispense:
630	643		309
631		-	(2) A ~~dispensing practitioner may not dispense:~~
	644	+	(a) a controlled substance as defined in Section 58-37-2;
632	645		310
633		-	(a) a ~~controlled substance as defined in Section~~ 58-~~37-2;~~
	646	+	(b) a drug or class of drugs that is designated by the division under Subsection 58-88-205
634	647		311
635		-	(b) ~~a drug~~ or ~~class of drugs that is designated by the division under Subsection 58-88-205~~
	648	+	(2); or
636	649		312
637		-	(2); or
	650	+	[(c) gabapentin; or]
638	651		313
639		-	[(c) ~~gabapentin; or]~~
	652	+	[(d)] (c) a supply of a drug under this part that exceeds a 30-day supply.
640	653		314
641		-	[(~~d)] (c~~) a ~~supply of~~ a ~~drug under this part that exceeds a 30-day supply.~~
	654	+	(3) A dispensing practitioner may not make a claim against workers' compensation or
642	655		315
643		-	~~(3)~~ A ~~dispensing practitioner may not make a claim against workers'~~ ~~compensation or~~
	656	+	automobile insurance for a drug dispensed under this part for outpatient use unless the
644	657		316
645		-	~~automobile insurance for~~ a ~~drug dispensed under this part for outpatient use unless~~ the
	658	+	dispensing practitioner is contracted with a pharmacy network established by the claim
646	659		317
647		-	~~dispensing practitioner is contracted with a pharmacy network established by the claim~~
	660	+	payor.
648	661		318
649		-	~~payor.~~
	662	+	(4) When a dispensing practitioner dispenses a drug to the patient under this part, a
650	663		319
651		-	~~(4) When a~~ dispensing practitioner ~~dispenses a drug to the patient under this part, a~~
	664	+	dispensing practitioner shall:
652	665		320
653		-	~~dispensing practitioner shall:~~
	666	+	(a) disclose to the patient verbally and in writing that the patient is not required to fill the
654	667		321
655		-	~~(a) disclose to~~ the ~~patient verbally~~ and ~~in writing~~ that the patient ~~is not required to fill the~~
	668	+	prescription through the licensed dispensing practice and that the patient has a right
656	669		322
657		-	prescription through ~~the licensed dispensing practice~~ and ~~that the patient has a right~~
	670	+	to fill the prescription through a pharmacy; and
658	671		323
659		-	~~to fill~~ the ~~prescription through a pharmacy;~~ ~~and~~
	672	+	(b) if the patient will be responsible to pay cash for the drug, disclose:
660	673		324
661		-	(b) if the patient will be responsible to pay cash for the drug~~, disclose:~~
	674	+	(i) that the patient will be responsible to pay cash for the drug; and
662	675		325
663		-	(i) that the patient will be ~~responsible to pay cash for~~ the ~~drug; and~~
	676	+	(ii) the amount that the patient will be charged by the licensed dispensing practice for
664	677		326
665		-	~~(ii)~~ the ~~amount that the patient will be charged by the licensed dispensing practice for~~
	678	+	the drug.
666	679		327
667		-	~~the drug.~~
	680	+	(5) This part does not:
668	681		328
669		-	(5) This part ~~does not:~~
	682	+	(a) require a dispensing practitioner to dispense a drug under this part;
670	683		329
671		-	(a) ~~require~~ a dispensing ~~practitioner to dispense a drug~~ under ~~this~~ part;
	684	+	(b) limit a health care prescriber from dispensing under Chapter 17b, Part 8, Dispensing
672	685		330
673		-	(b) limit a health care prescriber from dispensing under Chapter 17b, Part 8, Dispensing
	686	+	Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy; or
	687	+	- 10 - 02-26 10:10 H.B. 495
674	688		331
675		-	~~Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy; or~~
	689	+	(c) apply to a physician who dispenses:
676	690		332
677		-	(c) ~~apply~~ to a ~~physician who dispenses:~~
	691	+	(i) a drug sample, as defined in Section 58-17b-102, to a patient in accordance with
678	692		333
679		-	~~(i) a drug sample, as defined in~~ Section 58-17b-~~102, to a patient in accordance with~~
	693	+	Section 58-1-501.3 or Section 58-17b-610; or
680	694		334
681		-	Section 58-1-501.3 or Section 58-17b-610; or
682		-	- 10 - Enrolled Copy H.B. 495
	695	+	(ii) a drug in an emergency situation as defined by the division in rule under Chapter
683	696		335
684		-	~~(ii) a drug in an emergency situation as defined by the division in rule under Chapter~~
	697	+	17b, Pharmacy Practice Act.
685	698		336
686		-	~~17b, Pharmacy Practice Act.~~
	699	+	(6) A dispensing practitioner that is a dentist may dispense prescription fluoride medication
687	700		337
688		-	~~(6) A dispensing practitioner that~~ is ~~a dentist may dispense prescription fluoride medication~~
	701	+	regardless of whether the condition the fluoride is treating will last longer than 30 days.
689	702		338
690		-	~~regardless of whether the condition the fluoride is treating will last longer than 30 days~~.
	703	+	Section 5. Effective Date.
691	704		339
692		-	Section 5. Effective Date.
693		-	340
694	705		This bill takes effect on May 7, 2025.
695	706		- 11 -