COBI 2015 - Capitated Mental Health Services

Overview
Issues
Background
Financials

Sources Uses

FY 2016 Appropriation

In order to qualify for managed care Capitated Mental Health Services, a Medicaid client must live in a county covered by a Prepaid Mental Health Plan (PMHP) 1915(b) Freedom of Choice waiver. PMHPs cover 28 of Utah's 29 counties and provide inpatient hospital and outpatient mental health services through at-risk, capitated contracts. Local mental health authorities must provide the services or contract for them. In Wasatch County, the only county without a PMHP, mental health services are provided on a fee-for-service basis. A licensed mental health therapist must provide or supervise these services.

Funding History

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $146,567,200 from all sources for Capitated Mental Health Services. This is a 0 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $4,032,000 from the General/Education Funds, a change of 0 percent from revised Fiscal Year 2015 estimates.

A potential mental health client must receive a psychiatric diagnostic interview examination to assess the existence, nature, or extent of illness, injury or other health deviation for the purpose of determining the client's need for mental health services. Qualifying patients must have a written individual treatment plan. The treatment plan must contain measurable treatment goals related to problems identified in the psychiatric diagnostic interview examination. The treatment plan must focus on improving and/or stabilizing the client's condition. The provider must review treatment plans at least once every 6 months.

Intent Language

SB0002: Item 75

The Legislature intends that with the funding appropriated for the building block titled, "Intermediate Care Facilities - Intellectually Disabled," the Department of Health shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; In conjunction with Intermediate Care Facilities - Intellectually Disabled providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how Intermediate Care Facilities - Intellectually Disabled providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how Intermediate Care Facilities - Intellectually Disabled providers realize profit within the closed market of providing Intermediate Care Facilities - Intellectually Disabled services.

SB0002: Item 75

The Legislature intends that, if funds are available, Medicaid fee-for-service payments for anesthesia services be increased from the current amount of $18.27 to $23.73 for Fiscal Year 2016.

SB0002: Item 75

The Legislature intends that 5% of all funds provided in the Medicaid program for managed care dental plans be used for contracted plan administration and that any funds provided for the Affordable are Act premium tax not be included in that 5% administrative funds amount.

SB0003: Item 123

Under Section 63J-1-603 of the Utah Code the Legislature intends that up to $3,216,000 of the appropriations provided for the Medicaid Optional Services line item not lapse at the close of Fiscal Year 2016. The use of any nonlapsing funds is limited to a pilot program for assistance for children with disabilities and complex medical conditions to be used in similar amounts over three years with the goal of serving a similar number of clients over three years.

SB0007S01: Item 6

The Legislature intends that the Department of Health report on the following performance measures for the Medicaid Optional Services line item: (1) annual state general funds saved through preferred drug list (Target = $8.5 million general fund or more), (2) count of new choices waiver clients coming out of nursing homes into community based care (Target = 390 or more), and (3) emergency dental program savings (Target = $250,000 General Fund savings or more) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 18

Display By:

Funding Source

Expenditure Category

Appropriation Type:

Appropriation History by

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	5,053,500	508,700	2,156,500	4,508,500	5,876,000	(1,844,000)	4,032,000	0	4,032,000
General Fund, One-time	(2,048,900)	0	0	(4,500,000)	0	0	0	0	0
Federal Funds	113,547,900	97,561,800	101,100,500	98,103,700	101,374,000	443,400	101,817,400	0	101,817,400
American Recovery and Reinvestment Act	99,800	0	0	0	0	0	0	0	0
Dedicated Credits Revenue	22,177,800	31,024,900	31,507,400	32,634,600	31,507,400	1,127,200	32,634,600	0	32,634,600
Transfers - Human Services	0	0	1,708,900	0	0	0	0	0	0
Transfers - Medicaid - DHS	4,687,700	9,527,800	6,380,000	12,551,700	10,262,900	(3,699,600)	6,563,300	24,700	6,588,000
Transfers - Within Agency	0	286,300	1,504,000	0	0	0	0	0	0
Transfers - Workforce Services	0	0	0	70,100	125,500	(55,400)	70,100	0	70,100
Transfers - Youth Corrections	0	0	0	1,425,000	993,800	431,300	1,425,100	0	1,425,100
Beginning Nonlapsing	0	0	279,300	0	0	0	0	0	0
Lapsing Balance	0	0	0	(26,600)	0	0	0	0	0
Total	$143,517,800	$138,909,500	$144,636,600	$144,767,000	$150,139,600	($3,597,100)	$146,542,500	$24,700	$146,567,200

Show Table | Show Additional Information

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Other Charges/Pass Thru	143,517,800	138,909,500	144,636,600	144,767,000	150,139,600	(3,597,100)	146,542,500	24,700	146,567,200
Total	$143,517,800	$138,909,500	$144,636,600	$144,767,000	$150,139,600	($3,597,100)	$146,542,500	$24,700	$146,567,200

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.