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<leg xml:space="preserve" billnum="SB0160" sponsor="Todd Weiler" designation="SB" otherSponsor="Stephanie Gricius" otherHouse="House" sess="2026GS" fileno="2026FL1288" date="03-03-26" printDate="03-03 15:40" subVer="-2" minVer="2" office="LEGISLATIVE GENERAL COUNSEL" actionDate="" impact="code"><info><nextbuid>3</nextbuid><aminfo anum="0" effdate="05/06/2026"><seclist><sect action="A" src="code" buid="1" uid="C26B-3-S203_2026050620260506" fromuid="C26B-3-S203_2025110620251206" sort="26B03 02030020260506" mtype="section" effdate="05/06/2026">26B-3-203</sect><sect src="uncod" untype="effdate" buid="2" uid="EF0000" sort="UZEFF" mtype="uncod" effdate="05/06/2026"/></seclist></aminfo></info><tbox><sinfo><nextpairid>0</nextpairid></sinfo><st numlevel="1" lineno="1" slineno="0-1">Medicaid Reimbursement Rate Amendments</st><sessionhead>2026 GENERAL SESSION</sessionhead><statehead>STATE OF UTAH</statehead><sponsorhead>Chief Sponsor: Todd Weiler</sponsorhead><otherSponsorhead>House Sponsor: Stephanie Gricius</otherSponsorhead></tbox><lt numlevel="1" lineno="2" slineno="0-2"><lthead lineno="3">LONG TITLE</lthead><gdhead lineno="4">General Description:</gdhead><gd numlevel="1" lineno="5" slineno="0-5">This bill addresses Medicaid treatment rates.</gd><hphead lineno="6">Highlighted Provisions:</hphead><hp numlevel="1" lineno="7" slineno="0-7">This bill:<hl numlevel="1" lineno="8" slineno="0-8" level="1">makes permanent the budgeting mechanism under which Medicaid reimbursement rates <ln numlevel="1" lineno="9" slineno="0-9"/>for applied behavior analysis may increase.</hl></hp><moni numlevel="1" lineno="10" slineno="0-10" display="none">Money Appropriated in this Bill:</moni><moniNone lineno="11">None</moniNone><oc numlevel="1" lineno="12" slineno="0-12">Other Special Clauses:</oc><ocNone lineno="13">None</ocNone><sa numlevel="1" lineno="14" slineno="0-14">Utah Code Sections Affected:<saamd numlevel="1" lineno="15" slineno="0-15"><snhead>AMENDS:</snhead><sn num="26B-3-203" src="code" uid="C26B-3-S203_2026050620260506" buid="1" sort="26B03 02030020260506" numlevel="1" lineno="16" slineno="0-16"><bold>26B-3-203</bold>, as last amended by Laws of Utah 2025, First Special Session, Chapter 16</sn></saamd></sa></lt><enacthead lineno="17"/><enact numlevel="1" lineno="18" slineno="0-18">Be it enacted by the Legislature of the state of Utah:</enact><bdy><bsec buid="1" num="26B-3-203" type="amend" src="code" uid="C26B-3-S203_2026050620260506" sort="26B03 02030020260506" numlevel="1" lineno="19" slineno="1-1" sn="1"><section number="26B-3-203" numlevel="1" lineno="20" slineno="1-2" type="amend"><secline lineno="19">Section 1. Section <bold>26B-3-203</bold> is amended to read:</secline><catline lineno="20"><bold>26B-3-203<parens/>. Base budget appropriations for Medicaid accountable care <ln numlevel="1" lineno="21" slineno="1-3"/>organizations and behavioral health plans -- Forecast of behavioral health services cost, <ln numlevel="1" lineno="22" slineno="1-4"/>behavioral health plans, and ABA services -- Forecast of behavioral health services cost.</bold></catline><subsection ssid="1-null-1" dnum="1-o" numlevel="1" lineno="23" slineno="1-5" level="1" placement="noreturn"><display>(1)</display>As used in this section:<subsection ssid="1-null-2" dnum="a-o" numlevel="1" lineno="24" slineno="1-6" level="2"><display>(a)</display>"ABA service" means a service applying applied behavior analysis, as that term is <ln numlevel="1" lineno="25" slineno="1-7"/>defined in Section <xref depth="3" refnumber="31A-22-642">31A-22-642</xref>.</subsection><subsection ssid="1-null-3" dnum="b-o" numlevel="1" lineno="26" slineno="1-8" level="2"><display>(b)</display>"ABA service reimbursement rate" means the Medicaid reimbursement rate <ln numlevel="1" lineno="27" slineno="1-9"/>developed by the division, in accordance with Part <xref depth="2" refnumber="26B-3-1">1, Health Care Assistance</xref>, and <ln numlevel="1" lineno="28" slineno="1-10"/>paid to a provider for providing an ABA service.</subsection><subsection ssid="1-null-4" dnum="c-o" numlevel="1" lineno="29" slineno="1-11" level="2"><display>(c)</display>"ACO" means a Medicaid accountable care organization that contracts with the <ln numlevel="1" lineno="30" slineno="1-12"/>state's Medicaid program for:<subsection ssid="1-null-5" dnum="i-o" numlevel="1" lineno="31" slineno="1-13" level="3"><display>(i)</display>physical health services; or</subsection><subsection ssid="1-null-6" dnum="ii-o" numlevel="1" lineno="32" slineno="1-14" level="3"><display>(ii)</display>integrated physical and behavioral health services.</subsection></subsection><subsection ssid="1-null-7" dnum="d-o" numlevel="1" lineno="33" slineno="1-15" level="2"><display>(d)</display>"Base budget" means the same as that term is defined in legislative rule.</subsection><subsection ssid="1-null-8" dnum="e-o" numlevel="1" lineno="34" slineno="1-16" level="2"><display>(e)</display>"Behavioral health plan" means a managed care or fee-for-service delivery system <ln numlevel="1" lineno="35" slineno="1-17"/>that contracts with or is operated by the department to provide behavioral health <ln numlevel="1" lineno="36" slineno="1-18"/>services to Medicaid eligible individuals.</subsection><subsection ssid="1-null-9" dnum="f-o" numlevel="1" lineno="37" slineno="1-19" level="2"><display>(f)</display>"Behavioral health services" means mental health or substance use treatment or <ln numlevel="1" lineno="38" slineno="1-20"/>services.</subsection><subsection ssid="1-null-10" dnum="g-o" numlevel="1" lineno="39" slineno="1-21" level="2"><display>(g)</display>"General Fund growth factor" means the amount determined by dividing the next <ln numlevel="1" lineno="40" slineno="1-22"/>fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing <ln numlevel="1" lineno="41" slineno="1-23"/>appropriations from the General Fund.</subsection><subsection ssid="1-null-11" dnum="h-o" numlevel="1" lineno="42" slineno="1-24" level="2"><display>(h)</display>"Next fiscal year ongoing General Fund revenue estimate" means the next fiscal year <ln numlevel="1" lineno="43" slineno="1-25"/>ongoing General Fund revenue estimate identified by the Executive Appropriations <ln numlevel="1" lineno="44" slineno="1-26"/>Committee, in accordance with legislative rule, for use by the Office of the <ln numlevel="1" lineno="45" slineno="1-27"/>Legislative Fiscal Analyst in preparing budget recommendations.</subsection><subsection ssid="1-null-12" dnum="i-o" numlevel="1" lineno="46" slineno="1-28" level="2"><display>(i)</display>"Member" means an enrollee.</subsection><subsection ssid="1-null-13" dnum="j-o" numlevel="1" lineno="47" slineno="1-29" level="2"><display>(j)</display>"PMPM" means per-member-per-month funding.</subsection></subsection><subsection ssid="1-null-14" dnum="2-o" numlevel="1" lineno="48" slineno="1-30" level="1"><display>(2)</display>If the General Fund growth factor is less than 100%, the next fiscal year base budget <ln numlevel="1" lineno="49" slineno="1-31"/>shall, subject to Subsection <xref depth="4" refnumber="26B-3-203(5)">(5)</xref>, include an appropriation to the department in an amount <ln numlevel="1" lineno="50" slineno="1-32"/>necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health <ln numlevel="1" lineno="51" slineno="1-33"/>plans equals the current fiscal year PMPM for the ACOs and behavioral health plans <ln numlevel="1" lineno="52" slineno="1-34"/>multiplied by 100%.</subsection><subsection ssid="1-null-15" dnum="3-o" numlevel="1" lineno="53" slineno="1-35" level="1"><display>(3)</display>If the General Fund growth factor is greater than or equal to 100%, but less than 102%, <ln numlevel="1" lineno="54" slineno="1-36"/>the next fiscal year base budget shall, subject to Subsection <xref depth="4" refnumber="26B-3-203(5)">(5)</xref>, include an appropriation <ln numlevel="1" lineno="55" slineno="1-37"/>to the department in an amount necessary to ensure that the next fiscal year PMPM for <ln numlevel="1" lineno="56" slineno="1-38"/>ACOs and behavioral health plans equals the current fiscal year PMPM for the ACOs <ln numlevel="1" lineno="57" slineno="1-39"/>and behavioral health plans multiplied by the General Fund growth factor.</subsection><subsection ssid="1-null-16" dnum="4-o" numlevel="1" lineno="58" slineno="1-40" level="1"><display>(4)</display>If the General Fund growth factor is greater than or equal to 102%, the next fiscal year <ln numlevel="1" lineno="59" slineno="1-41"/>base budget shall, subject to Subsection <xref depth="4" refnumber="26B-3-203(5)">(5)</xref>:<subsection ssid="1-null-17" dnum="a-o:_-e" numlevel="1" lineno="60" slineno="1-42" ea="erase" anum="0" owner="admin" style="2" level="2"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1016" style="2" owner="o" level="1" deltag="start">(a)</amend></display><amend anum="0" ea="erase" pairid="18" groupid="16" style="2" owner="admin" level="1" deltag="end">in fiscal years 2025 and 2026:</amend><amendoutend style="2"/></subsection><subsection ssid="1-null-18" dnum="i-o:a-e" numlevel="1" lineno="61" slineno="1-43" level="2"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1017" style="2" owner="o" level="1" deltag="both">(i)</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="1018" style="1" owner="e" level="1" amendtag="both" space="true">(a)</amend></display>include an appropriation to the department in an amount that would, prior to the <ln numlevel="1" lineno="62" slineno="1-44"/>application of Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="34" groupid="32" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(b)">(4)(a)(ii)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="27" groupid="25" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(b)" depth="4">(4)(b)</xref></amend>, allow the department to ensure that the <ln numlevel="1" lineno="63" slineno="1-45"/>next fiscal year PMPMs for ACOs and behavioral health plans is greater than or <ln numlevel="1" lineno="64" slineno="1-46"/>equal to the current fiscal year PMPMs for the ACOs and behavioral health plans <ln numlevel="1" lineno="65" slineno="1-47"/>multiplied by 102%;</subsection><subsection ssid="1-null-19" dnum="ii-o:b-e" numlevel="1" lineno="66" slineno="1-48" level="2"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1018" style="2" owner="o" level="1" deltag="both">(ii)</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="1019" style="1" owner="e" level="1" amendtag="both" space="true">(b)</amend></display>subject to Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="35" groupid="33" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(c)">(4)(a)(iii)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="28" groupid="26" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(c)" depth="4">(4)(c)</xref></amend>, allocate the amount appropriated under <ln numlevel="1" lineno="67" slineno="1-49"/>Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="36" groupid="34" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(a)">(4)(a)(i)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="29" groupid="27" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(a)" depth="4">(4)(a)</xref></amend> to provide substantially the same year-over-year <ln numlevel="1" lineno="68" slineno="1-50"/>percentage point increase to:<subsection ssid="1-null-20" dnum="A-o:i-e" numlevel="1" lineno="69" slineno="1-51" level="3"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1019" style="2" owner="o" level="1" deltag="both">(A)</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="1020" style="1" owner="e" level="1" amendtag="both" space="true">(i)</amend></display>the PMPMs for ACOs and behavioral health plans; and</subsection><subsection ssid="1-null-21" dnum="B-o:ii-e" numlevel="1" lineno="70" slineno="1-52" level="3"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1020" style="2" owner="o" level="1" deltag="both">(B)</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="1021" style="1" owner="e" level="1" amendtag="both" space="true">(ii)</amend></display>each ABA service reimbursement rate; and</subsection></subsection><subsection ssid="1-null-22" dnum="iii-o:c-e" numlevel="1" lineno="71" slineno="1-53" level="2"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1021" style="2" owner="o" level="1" deltag="both">(iii)</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="1022" style="1" owner="e" level="1" amendtag="both" space="true">(c)</amend></display>for the initial appropriation under Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="37" groupid="35" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(a)">(4)(a)(i)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="30" groupid="28" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(a)" depth="4">(4)(a)</xref></amend>, prior to providing <ln numlevel="1" lineno="72" slineno="1-54"/>the percentage point increases under Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="38" groupid="36" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(b)">(4)(a)(ii)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="31" groupid="29" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(b)" depth="4">(4)(b)</xref></amend>, allocate from the <ln numlevel="1" lineno="73" slineno="1-55"/>total amount appropriated under Subsection <amendoutstart style="2"/><amend anum="0" ea="erase" pairid="39" groupid="37" style="2" owner="admin" level="1" deltag="both"><xref depth="4" refnumber="26B-3-203(4)(a)">(4)(a)(i)</xref></amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="32" groupid="30" style="1" owner="admin" level="1" amendtag="both" space="true"><xref refnumber="(4)(a)" depth="4">(4)(a)</xref></amend> an amount necessary to <ln numlevel="1" lineno="74" slineno="1-56"/>increase and substantially equalize each of the ABA service reimbursement rates with <ln numlevel="1" lineno="75" slineno="1-57"/>a corresponding reimbursement rate paid for providing the same or substantially <ln numlevel="1" lineno="76" slineno="1-58"/>similar service under an ACO or a behavioral health plan<amendoutstart style="2"/><amend anum="0" ea="erase" pairid="19" groupid="17" style="2" owner="admin" level="1" deltag="both">; and</amend><amendoutend style="2"/><amend anum="0" ea="amend" pairid="33" groupid="31" style="1" owner="admin" level="1" amendtag="both" space="true">.</amend></subsection><subsection ssid="1-null-23" dnum="b-o:_-e" numlevel="1" lineno="77" slineno="1-59" ea="erase" anum="0" owner="admin" style="2" level="2"><display><amendoutstart style="2"/><amend anum="0" ea="erase" pairid="1022" style="2" owner="o" level="1" deltag="start">(b)</amend></display><amend anum="0" ea="erase" pairid="9" groupid="8" style="2" owner="admin" level="1" deltag="end">beginning in fiscal year 2027, include an appropriation to the department in an <ln numlevel="1" lineno="78" slineno="1-60"/>amount necessary to ensure that the next fiscal year PMPMs for ACOs and <ln numlevel="1" lineno="79" slineno="1-61"/>behavioral health plans is greater than or equal to the current fiscal year PMPMs for <ln numlevel="1" lineno="80" slineno="1-62"/>the ACOs and the behavioral health plans multiplied by 102%, and less than or equal <ln numlevel="1" lineno="81" slineno="1-63"/>to the current fiscal year PMPMs for the ACOs and the behavioral health plans <ln numlevel="1" lineno="82" slineno="1-64"/>multiplied by the General Fund growth factor.</amend><amendoutend style="2"/></subsection></subsection><subsection ssid="1-null-24" dnum="5-o" numlevel="1" lineno="83" slineno="1-65" level="1"><display>(5)</display>The appropriations provided to the department for behavioral health plans under this <ln numlevel="1" lineno="84" slineno="1-66"/>section shall be reduced by the amount contributed by counties in the current fiscal year <ln numlevel="1" lineno="85" slineno="1-67"/>for behavioral health plans in accordance with Subsections <xref depth="4" refnumber="17-77-201(5)(k)">17-77-201(5)(k)</xref> and <xref depth="4" refnumber="17-77-301(5)(a)(x)"><ln numlevel="1" lineno="86" slineno="1-68"/>17-77-301(5)(a)(x)</xref>.</subsection><subsection ssid="1-null-25" dnum="6-o" numlevel="1" lineno="87" slineno="1-69" level="1"><display>(6)</display>In order for the department to estimate the impact of Subsections <xref depth="4" refnumber="26B-3-203(2)">(2)</xref> through <xref depth="4" refnumber="26B-3-203(4)">(4)</xref> before <ln numlevel="1" lineno="88" slineno="1-70"/>identification of the next fiscal year ongoing General Fund revenue estimate, the <ln numlevel="1" lineno="89" slineno="1-71"/>Governor's Office of Planning and Budget shall, in cooperation with the Office of the <ln numlevel="1" lineno="90" slineno="1-72"/>Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the <ln numlevel="1" lineno="91" slineno="1-73"/>next fiscal year and provide the estimate to the department no later than November 1 of <ln numlevel="1" lineno="92" slineno="1-74"/>each year.</subsection><subsection ssid="1-null-26" dnum="7-o" numlevel="1" lineno="93" slineno="1-75" level="1"><display>(7)</display>The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of <ln numlevel="1" lineno="94" slineno="1-76"/>behavioral health services in any state Medicaid funding or savings forecast that is <ln numlevel="1" lineno="95" slineno="1-77"/>completed in coordination with the department and the Governor's Office of Planning <ln numlevel="1" lineno="96" slineno="1-78"/>and Budget.</subsection></section></bsec><bsec buid="2" type="uncod" untype="effdate" src="uncod" uid="EF0000" sort="UZEFF" langlock="true" numlevel="1" lineno="97" slineno="2-1" sn="2"><section type="uncod" untype="effdate" display="false" src="uncod"><secline lineno="97">Section 2.  <bold>Effective Date.</bold></secline><sectionText lineno="98"><amend anum="0" ea="amend" pairid="1" groupid="1" style="1" owner="admin" level="1" amendtag="both">This bill takes effect on <effdate uid="code" date="5/6/2026">May 6, 2026</effdate>.</amend></sectionText></section></bsec></bdy><foot><rev><tm>3-3-26 3:18 PM</tm></rev></foot></leg>