Utah Code 31A-44-204. Actuarial review
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(1)
Terms Used In Utah Code 31A-44-204
- Continuing care: means furnishing or providing access to an individual, other than by an individual related to the individual by blood, marriage, or adoption, of lodging together with nursing services, medical services, or other related services pursuant to a contract requiring an entrance fee. See Utah Code 31A-44-102
- Department: means the Insurance Department. See Utah Code 31A-1-301
- Entrance fee: includes a monthly fee, assessed at a rate that is greater than the value of the provider's monthly services, that a resident agrees to pay in exchange for acceptance into a facility or a promise of future monthly fees assessed at a rate that is less than the value of the services rendered. See Utah Code 31A-44-102
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
- Provider: means :(9)(a)(i) the owner of a facility;(9)(a)(ii) a person, other than a resident, that claims a possessory interest in a facility; or(9)(a)(iii) a person who enters into a continuing care contract with a resident or potential resident. See Utah Code 31A-44-102(1)(a) This section applies only to a provider that directly or indirectly offers a future guarantee of continuing care that the department determines develops current actuarial liabilities.(1)(b) This section does not apply to a provider that offers continuing care under a fee-for-service model with a required entrance fee.
(2) A provider subject to this section shall file, with the department, an actuarial review:
(2)(a) upon being notified of the department’s determination; and
(2)(b) on a day designated by the department in the year five years after the day on which the department last received an actuarial review from the provider.
(3) The department may require an actuarial review in addition to the actuarial reviews required by Subsection (2) if the department determines that the provider shows an indication of financial instability.