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.
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.
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.