Senator Lincoln Fillmore proposes the following substitute bill:


1     
MENTAL HEALTH SERVICES IN SCHOOLS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Lincoln Fillmore

5     
House Sponsor: Susan Pulsipher

6     

7     LONG TITLE
8     General Description:
9          This bill enacts provisions relating to coverage of certain mental health services by the
10     Medicaid program and certain health insurers.
11     Highlighted Provisions:
12          This bill:
13          ▸     requires the Department of Health to develop a proposal and submit a state plan
14     amendment to allow the state Medicaid program to be billed for certain mental
15     health services provided in a public school;
16          ▸     prohibits certain health benefit plans offered on or after January 1, 2020, from
17     denying a claim for mental health services solely because they are provided by a
18     public school employee or in a public school; and
19          ▸     prohibits a local education agency from billing for certain health care services.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     ENACTS:

26          26-18-419, Utah Code Annotated 1953
27          31A-22-650, Utah Code Annotated 1953
28          53G-7-217, Utah Code Annotated 1953
29     

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 26-18-419 is enacted to read:
32          26-18-419. Medicaid waiver for coverage of mental health services in schools.
33          (1) As used in this section, "local education agency" means:
34          (a) a school district;
35          (b) a charter school; or
36          (c) the Utah Schools for the Deaf and the Blind.
37          (2) In consultation with the Department of Human Services and the State Board of
38     Education, the department shall develop a proposal to allow the state Medicaid program to
39     reimburse a local education agency, a local mental health authority, or a private provider for
40     covered mental health services provided:
41          (a) in accordance with Section 53E-9-203; and
42          (b) (i) at a local education agency building or facility; or
43          (ii) by an employee or contractor of a local education agency.
44          (3) Before January 1, 2020, the department shall apply to CMS for a state plan
45     amendment to implement the coverage described in Subsection (2).
46          Section 2. Section 31A-22-650 is enacted to read:
47          31A-22-650. Coverage for mental health services in schools.
48          (1) As used in this section, "local education agency" means:
49          (a) a school district;
50          (b) a charter school; or
51          (c) the Utah Schools for the Deaf and the Blind.
52          (2) A health benefit plan that is entered into or renewed on or after January 1, 2020,
53     may not deny a claim for a covered mental health service solely because the mental health
54     service is provided:
55          (a) at a local education agency building or facility; or
56          (b) by an employee or contractor of a local education agency.

57          (3) Nothing in this section:
58          (a) prohibits a health benefit plan from denying a claim:
59          (i) by an individual that is not a licensed health care provider;
60          (ii) by a health care provider practicing outside the health care provider's scope of
61     practice;
62          (iii) that is submitted by a person that is not a network provider;
63          (iv) for a mental health service that is not medically necessary as determined by the
64     health benefit plan; or
65          (v) that does not otherwise comply with the health benefit plan's policies; or
66          (b) requires a health benefit plan to pay a claim for a service that is:
67          (i) provided under an individualized education program as defined in Section
68     53E-4-301; or
69          (ii) administrative in nature to the local education agency.
70          Section 3. Section 53G-7-217 is enacted to read:
71          53G-7-217. Prohibition on billing for certain health care services.
72          A local education agency, or an employee or contractor of a local education agency,
73     may not bill:
74          (1) a health benefit plan as defined in Section 31A-1-301, for any service that is:
75          (a) provided under an individualized education program as defined in Section
76     53E-4-301; or
77          (b) administrative in nature to the local education agency; or
78          (2) a student or a student's family for a service that is:
79          (a) performed by the local education agency or an employee or contractor of a local
80     education agency; and
81          (b) not covered by the student's health benefit plan.