ut-20260915-R414-340: R414-340. Health Care Transparency and Accountability

1. Agency Information

Title catchline: Health and Human Services, Integrated Healthcare Building: Cannon Health Building Street address: 288 N 1460 W City, state: Salt Lake City, UT Mailing address: PO Box 143325 City, state and zip: Salt Lake City, UT 84114-3325

2. Contact Persons

Name: Phone: Email: Craig Devashrayee 801-915-4493 cdevashrayee@utah.gov Mariah Noble 385-214-1150 mariahnoble@utah.gov Please address questions regarding information on this notice to the persons listed above.

A. Rule or section catchline:

R414-340. Health Care Transparency and Accountability

B. Purpose of the new rule or reason for the change:

In accordance with HB 566, passed in the 2026 General Session, the purpose of this proposed rule is to implement new rulemaking requirements from Sections 26B-3-1202 and 26B-3-1203 that address transparency within the Medicaid program in relation to payments, published reports, and data submitted by managed care plans.

C. Summary of the new rule or change:

This rule establishes procedures for the Division of Integrated Healthcare (division) to develop and maintain a Medicaid data dashboard with information furnished by managed care plans. 96 UTAH STATE BULLETIN, September 15, 2026, Vol. 2026, No. 18 NOTICES OF PROPOSED RULES It also sets forth obligations for risk contractors and subcontractors regarding dashboard data submissions, improper payment identification and remediation, and sanctions for noncompliance by risk contractors of related requirements. 4. Legislative Action Information

B. If yes, any bill number and HB 566 (2026 General Session)

session: 5. Fiscal Information Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

This filing is not anticipated to create a fiscal impact to the state budget, as this filing implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). Any fiscal impact to the state budget resulting from HB 566 (2026) can be found in the fiscal note for this bill at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf.

B. Local governments:

This filing is not anticipated to create a fiscal impact to local governments, as this filing implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). Any fiscal impact to local governments resulting from HB 566 (2026) can be found in the fiscal note for this bill at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf.

C. Small businesses ("small business" means a business employing 1-49 persons):

This filing is not anticipated to create a fiscal impact to small businesses, as this filing implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). Any fiscal impact to small businesses resulting from resulting from HB 566 (2026) can be found in the fiscal note for this bill at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

This filing is not anticipated to create a fiscal impact to non-small businesses, as this filing implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). Any fiscal impact to non-small businesses resulting from HB 566 (2026) can be found in the fiscal note for this bill at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf. E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency): This filing is not anticipated to create a fiscal impact to other persons, as this filing implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). Any fiscal impact to Medicaid members and entities outside of government or business resulting from HB 566 (2026) can be found in the fiscal note for this bill at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf.

F. Compliance costs for affected persons:

This filing is not anticipated to generate any compliance costs for affected persons, as it implements statutory requirements from Sections 26B-3-1202 and 26B-3-1203, enacted through HB 566 (2026). UTAH STATE BULLETIN, September 15, 2026, Vol. 2026, No. 18 97 NOTICES OF PROPOSED RULES This bill's fiscal note can be found at: https://pf.utleg.gov/public-web/sessions/2026GS/fiscal-notes/HB0566S03.fn.pdf. 6. Regulatory Impact Summary Table Enter the cost or savings in the relevant cell. If there is no cost or savings, enter, "$0." If a cost or savings is inestimable, enter, "inestimable." Fiscal Cost FY2027 FY2028 FY2029 FY2030 FY2031 State Budget $0 $0 $0 $0 $0 Local Governments $0 $0 $0 $0 $0 Small Businesses $0 $0 $0 $0 $0 Non-Small Businesses $0 $0 $0 $0 $0 Other Persons $0 $0 $0 $0 $0 Total Fiscal Cost $0 $0 $0 $0 $0 Fiscal Benefits FY2027 FY2028 FY2029 FY2030 FY2031 State Budget $0 $0 $0 $0 $0 Local Governments $0 $0 $0 $0 $0 Small Businesses $0 $0 $0 $0 $0 Non-Small Businesses $0 $0 $0 $0 $0 Other Persons $0 $0 $0 $0 $0 Total Fiscal Benefits $0 $0 $0 $0 $0 Net Fiscal Benefits $0 $0 $0 $0 $0 7. Regulatory Impact Analysis Approval The Commissioner of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis. 8. Family Impact Information

A. The agency has considered this rule's impact on family health, stability, and fo☒mation:

9. Citation Information Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement: Section 26B-1-213 Section 26B-3-108 Section 26B-3-1202 Section 26B-3-1203 11. Public Notice Information The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until: 10/15/2026

12. Effective Date Information This rule change MAY become effective on: 10/22/2026 (NOTE: This is the date the agency anticipates making the filing effective. It is NOT the effective date) 13. Agency Authorization Information Agency head or Tracy S. Gruber, Commissioner Date: 08/29/2026 designee and title: 98 UTAH STATE BULLETIN, September 15, 2026, Vol. 2026, No. 18 NOTICES OF PROPOSED RULES R414. Health and Human Services, Integrated Healthcare. R414-340. Health Care Transparency andAccountability. R414-340-1. Authority and Purpose. (1)(a) Sections 26B-3-1202 and 26B-3-1203 authorize this rule. (b) This rule is in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. No. 104-191, 110 Stat. 1936. (2) This rule implements health care transparency and accountability specified in Sections 26B-3-1201, 26B-3-1202, and 26B-3- 1203 by: (a) establishing procedures for the Division of Integrated Healthcare (division) to develop and maintain a Medicaid data dashboard with information furnished by managed care plans; and (b) setting forth obligations for a risk contractor or subcontractor regarding dashboard data submissions, improper payment identification and remediation, and sanctions for noncompliance with related requirements. R414-340-2. Definitions. Terms used in this rule are defined in Section 26B-3-1201. R414-340-3. Managed Care Organization Data Submission. (1) Consistent with Section 26B-3-1202, a risk contractor shall submit to the division in a division-specified format: (a) total spending on non-claims expenditures, as required by the division; (b) total spending on non-benefit services, as required by the division; and (c) total spending on optional Medicaid benefits, including value add benefits, as required by the division. (2) Each risk contractor shall submit an initial data report to the division with data described in Subsection (1) for the period of January 1, 2023, through September 30, 2026. (3) The initial data report is due to the division by November 1, 2026. (4)(a) Any report after the initial data report is due from the risk contractor by the first day of the month following the month after the preceding quarter. (b) A risk contractor shall submit to the division the first quarterly report by February 1, 2027, for the period of October 1, 2026, through December 31, 2026. (5) A risk contractor shall provide required data in a HIPAA-compliant manner consistent with 45 CFR 160, 162, and 164 (2026) and without protected health information. (6) A risk contractor shall ensure each submitted data report complies with accessibility standards consistent with the Americans with DisabilitiesAct (ADA) Title II Web Regulation set forth in 28 CFR 35 (2026). (7) Each managed care organization shall submit to the division complete copies of data, reports, and disclosures submitted to the Centers for Medicare and Medicaid Services (CMS) no later than 30 days after submission to CMS. (a) A risk contractor shall redact a submission to the division as appropriate in compliance with HIPAA standards and requirements for public posting of information. (b) A risk contractor shall ensure each redaction is consistent with the ADATitle II Web Regulation for accessibility set forth in 28 CFR 35. R414-340-4. Improper Payments and CorrectiveAction. (1) Consistent with Section 26B-3-1203, each risk contractor and subcontractor, as defined in Section 26B-1201, shall submit a quarterly report to the division in a division-specified format of: (a) any improper payment; (b) a root cause analysis for each type of improper payment; and (c) the related corrective action plan for the improper payment. (2) Each subcontractor shall submit a quarterly report to the parent risk contractor within 45 calendar days after the end of the preceding quarter. (3) A risk contractor shall submit a quarterly report, including any subcontractor's report, as described in Subsection (2), to the division by the first day of the month following the month after the preceding quarter. (4) A risk contractor shall submit to the division the first quarterly report by February 1, 2027, for the period of October 1, 2026, through December 31, 2026. (5) A risk contractor shall repay the Department of Health and Human Services (department) for any improper payment, consistent with the managed care reimbursement model and the risk contractor's corresponding managed care contract, no later than 30 calendar days after the day on which the report described in Subsection (1) is due. (6) A subcontractor shall repay the parent risk contractor for any improper payment no later than 30 calendar days after the day on which the report described in Subsection (2) is due to the parent risk contractor. (7) A risk contractor shall correct the encounter data record, as appropriate, in accordance with the risk contractor's managed care contract with the department. R414-340-5. Noncompliance Penalties. The division shall assess any liquidated damage to a risk contractor that fails to submit a complete and timely report by the due date required by this rule, including any applicable subcontractor report, consistent with the risk contractor's contract with the division. UTAH STATE BULLETIN, September 15, 2026, Vol. 2026, No. 18 99 NOTICES OF PROPOSED RULES KEY: Medicaid Date of Last Change: 2026 Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-1202; 26B-3-1203 NOTICE OF SUBSTANTIVE CHANGE TYPE OF FILING: Amendment Filing ID: 58201