1     
BEHAVIORAL HEALTH AMENDMENTS

2     
2022 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Steve Eliason

5     
Senate Sponsor: Todd D. Weiler

6     

7     LONG TITLE
8     General Description:
9          This bill addresses behavioral health services.
10     Highlighted Provisions:
11          This bill:
12          ▸     creates and modifies definitions;
13          ▸     requires the base budget to include certain appropriations to the Department of
14     Health for behavioral health services;
15          ▸     requires the Office of the Legislative Fiscal Analyst to include an estimate of the
16     cost of behavioral health services in certain Medicaid funding forecasts;
17          ▸     creates the Collaborative Care Grant Program;
18          ▸     requires the Division of Substance Abuse and Mental Health to administer the
19     collaborative care grant program;
20          ▸     allows the state suicide prevention program to include a public education campaign;
21          ▸     clarifies that the Governor's Suicide Prevention Fund may be used for components
22     of the state suicide prevention program;
23          ▸     provides a sunset date;
24          ▸     includes reporting requirements; and
25          ▸     makes technical and conforming changes.
26     Money Appropriated in this Bill:
27          This bill appropriates in fiscal year 2023:
28          ▸     to Department of Health and Human Services -- Health Care Administration --
29     Integrated Health Care Administration, as a one-time appropriation:
30               •     from General Fund, One-time, $1,000,000;
31          ▸     to Department of Health and Human Services -- Integrated Health Care Services --
32     Non-Medicaid Behavioral Health Treatment and Crisis Response, as an ongoing
33     appropriation:
34               •     from General Fund, $350,000; and
35          ▸     to Department of Health and Human Services -- Integrated Health Care Services --
36     Non-Medicaid Behavioral Health Treatment and Crisis Response, as a one-time
37     appropriation:
38               •     from General Fund, One-time, $2,430,000.
39     Other Special Clauses:
40          This bill provides a special effective date.
41     Utah Code Sections Affected:
42     AMENDS:
43          26-18-405.5 (Effective 07/01/22), as last amended by Laws of Utah 2021, Chapter 404
44          62A-15-1101, as last amended by Laws of Utah 2019, Chapters 136, 440 and last
45     amended by Coordination Clause, Laws of Utah 2019, Chapter 440
46          62A-15-1103, as enacted by Laws of Utah 2018, Chapter 414
47          63I-1-262, as last amended by Laws of Utah 2021, Chapters 29 and 91
48     ENACTS:
49          62A-15-124, Utah Code Annotated 1953
50     

51     Be it enacted by the Legislature of the state of Utah:
52          Section 1. Section 26-18-405.5 (Effective 07/01/22) is amended to read:
53          26-18-405.5 (Effective 07/01/22). Base budget appropriations for Medicaid
54     accountable care organizations and behavioral health plans -- Forecast of behavioral
55     health services cost.
56          (1) As used in this section:
57          (a) "ACO" means an accountable care organization that contracts with the state's
58     Medicaid program for:
59          (i) physical health services; or
60          (ii) integrated physical and behavioral health services.
61          (b) "Base budget" means the same as that term is defined in legislative rule.
62          (c) "Behavioral health plan" means a managed care or fee for service delivery system
63     that contracts with or is operated by the department to provide behavioral health services to
64     Medicaid eligible individuals.
65          (d) "Behavioral health services" means mental health or substance use treatment or
66     services.
67          [(c)] (e) "General Fund growth factor" means the amount determined by dividing the
68     next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
69     appropriations from the General Fund.
70          [(d) "Mental health plan" means a prepaid mental health plan or a health plan that uses
71     a fee-for-service payment model that contracts with the state's Medicaid program for behavioral
72     health services.]
73          [(e)] (f) "Next fiscal year ongoing General Fund revenue estimate" means the next
74     fiscal year ongoing General Fund revenue estimate identified by the Executive Appropriations
75     [Subcommittee] Committee, in accordance with legislative rule, for use by the Office of the
76     Legislative Fiscal Analyst in preparing budget recommendations.
77          [(f)] (g) "PMPM" means per-member-per-month funding.
78          (2) If the General Fund growth factor is less than 100%, the next fiscal year base
79     budget shall, subject to Subsection (5), include an appropriation[: (a)] to the department [for
80     ACOs under the department] in an amount necessary to ensure that the next fiscal year PMPM
81     for [the] ACOs and behavioral health plans equals the current fiscal year PMPM for the ACOs
82     and behavioral health plans multiplied by 100%[; and].
83          [(b) subject to Subsection (5), to the Department of Human Services for mental health
84     plans under the Department of Human Services in an amount necessary to ensure that the
85     funding for the mental health plans in the next fiscal year equals the funding for the mental
86     health plans in the current fiscal year multiplied by 100%.]
87          (3) If the General Fund growth factor is greater than or equal to 100%, but less than
88     102%, the next fiscal year base budget shall, subject to Subsection (5), include an
89     appropriation[: (a)] to the department [for ACOs under the department] in an amount necessary
90     to ensure that the next fiscal year PMPM for [the] ACOs and behavioral health plans equals the
91     current fiscal year PMPM for the ACOs and behavioral health plans multiplied by the General
92     Fund growth factor[; and].
93          [(b) subject to Subsection (5), to the Department of Human Services for mental health
94     plans under the Department of Human Services in an amount necessary to ensure that the
95     funding for the mental health plans in the next fiscal year equals the funding for the mental
96     health plans in the current fiscal year multiplied by the General Fund growth factor.]
97          (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal
98     year base budget shall, subject to Subsection (5), include an appropriation[: (a)] to the
99     department [for ACOs under the department] in an amount necessary to ensure that the next
100     fiscal year PMPM for [the] ACOs and behavioral health plans is greater than or equal to the
101     current fiscal year PMPM for the ACOs and behavioral health plans multiplied by 102% and
102     less than or equal to the current fiscal year PMPM for the ACOs and behavioral health plans
103     multiplied by the General Fund growth factor[; and].
104          [(b) subject to Subsection (5), to the Department of Human Services for mental health
105     plans under the Department of Human Services in an amount necessary to ensure that the
106     funding for the mental health plans in the next fiscal year is greater than or equal to the funding
107     for the mental health plans in the current fiscal year multiplied by 102% and less than or equal
108     to the funding for the mental health plans in the current fiscal year multiplied by the General
109     Fund growth factor.]
110          (5) The appropriations provided to the [Department of Human Services] department for
111     behavioral health plans under this section shall be reduced by the amount contributed by
112     counties in the current fiscal year for [mental] behavioral health plans [under the Department of
113     Human Services] in accordance with Subsections 17-43-201(5)(k) and 17-43-301(6)(a)(x).
114          (6) In order for the department [and the Department of Human Services] to estimate the
115     impact of Subsections (2) through (4) before identification of the next fiscal year ongoing
116     General Fund revenue estimate, the Governor's Office of Planning and Budget shall, in
117     cooperation with the Office of the Legislative Fiscal Analyst, develop an estimate of ongoing
118     General Fund revenue for the next fiscal year and provide the estimate to the department [and
119     the Department of Human Services] no later than November 1 of each year.
120          (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
121     behavioral health services in any state Medicaid funding or savings forecast that is completed
122     in coordination with the department and the Governor's Office of Planning and Budget.
123          Section 2. Section 62A-15-124 is enacted to read:
124          62A-15-124. Collaborative care grant program.
125          (1) As used in this section:
126          (a) "Applicant" means a small primary health care practice that applies for a grant
127     under this section.
128          (b) "Care manager" means an individual who plans, directs, and coordinates health care
129     services for a patient.
130          (c) "Collaborative care model" means a formal collaborative arrangement between a
131     primary care physician, a mental health professional, and a care manager, to provide integrated
132     physical and behavioral health services.
133          (d) "Mental health professional" means an individual licensed under Title 58, Chapter
134     60, Mental Health Professional Practice Act, or Title 58, Chapter 61, Psychologist Licensing
135     Act, or a psychiatrist.
136          (e) "Physician" means an individual licensed to practice as a physician or osteopath
137     under Title 58, Chapter 67, Utah Medical Practice Act, or Title 58, Chapter 68, Utah
138     Osteopathic Medical Practice Act.
139          (f) "Primary care physician" means a physician that provides health services related to
140     family medicine, internal medicine, pediatrics, obstetrics, gynecology, or geriatrics.
141          (g) "Program" means a program described in Subsection (2)(a).
142          (h) "Psychiatrist" means a physician who is board eligible for a psychiatry
143     specialization recognized by the American Board of Medical Specialists or the American
144     Osteopathic Association's Bureau of Osteopathic Specialists.
145          (i) "Small primary health care practice" means a medical practice of primary health
146     care physicians that:
147          (i) includes 10 or fewer primary care physicians; or
148          (ii) is primarily based in a county of the third through sixth class, as classified in
149     Section 17-50-501.
150          (2) (a) Before July 1, 2022, the division shall solicit applications from small primary
151     health care practices for a grant to support or implement a program to provide integrated
152     physical and behavioral health services under a collaborative care model.
153          (b) A grant under this section may be used to:
154          (i) hire and train staff to administer a program;
155          (ii) identify and formalize contractual relationships with mental health professionals
156     and case managers to implement a program; or
157          (iii) purchase or upgrade software and other resources necessary to support or
158     implement a program.
159          (c) The division shall approve at least one but not more than six applications each year.
160          (d) The division shall determine which applicants receive a grant under this section
161     before December 31, 2022.
162          (3) An application for a grant under this section shall:
163          (a) identify the population to whom the applicant will provide services under a
164     program;
165          (b) identify the small primary health care practice's current resources that are used to
166     provide integrated physical and behavioral health services;
167          (c) explain how the population described in Subsection (3)(a) will benefit from the
168     program;
169          (d) provide details regarding:
170          (i) how the applicant will provide timely and effective services under the program;
171          (ii) any existing or planned contracts or partnerships between the applicant and other
172     persons that are related to a collaborative care model;
173          (iii) the methods the applicant will use to:
174          (A) protect the privacy of each individual to whom the applicant provides services
175     under the program; and
176          (B) collect non-identifying data; and
177          (e) provide other information requested by the division for the division to evaluate the
178     application.
179          (4) In evaluating an application for a grant under this section, the division shall
180     consider:
181          (a) the extent to which providing the grant to the applicant will fulfill the purpose of
182     providing increased integrated physical and behavioral health services; and
183          (b) the extent to which the population described in Subsection (3)(a) is likely to benefit
184     from the applicant receiving the grant.
185          (5) Before July 1, 2023, the division shall submit a written report to the Health and
186     Human Services Interim Committee regarding each applicant the division provided a grant to
187     in the preceding year under this section.
188          (6) Before July 1, 2024, the division shall submit a written report to the Health and
189     Human Services Interim Committee regarding:
190          (a) data gathered and knowledge gained in relation to providing grants to an applicant;
191     and
192          (b) recommendations for how the state can better implement integrated physical and
193     behavioral health services.
194          Section 3. Section 62A-15-1101 is amended to read:
195          62A-15-1101. Suicide prevention -- Reporting requirements.
196          (1) The division shall appoint a state suicide prevention coordinator to administer a
197     state suicide prevention program composed of suicide prevention, intervention, and postvention
198     programs, services, and efforts.
199          (2) The coordinator shall:
200          (a) establish a Statewide Suicide Prevention Coalition with membership from public
201     and private organizations and Utah citizens; and
202          (b) appoint a chair and co-chair from among the membership of the coalition to lead
203     the coalition.
204          (3) The state suicide prevention program may include the following components:
205          (a) delivery of resources, tools, and training to community-based coalitions;
206          (b) evidence-based suicide risk assessment tools and training;
207          (c) town hall meetings for building community-based suicide prevention strategies;
208          (d) suicide prevention gatekeeper training;
209          (e) training to identify warning signs and to manage an at-risk individual's crisis;
210          (f) evidence-based intervention training;
211          (g) intervention skills training; [and]
212          (h) postvention training[.]; or
213          (i) a public education campaign to improve public awareness about warning signs of
214     suicide and suicide prevention resources.
215          (4) The coordinator shall coordinate with the following to gather statistics, among
216     other duties:
217          (a) local mental health and substance abuse authorities;
218          (b) the State Board of Education, including the public education suicide prevention
219     coordinator described in Section 53G-9-702;
220          (c) the Department of Health;
221          (d) health care providers, including emergency rooms;
222          (e) federal agencies, including the Federal Bureau of Investigation;
223          (f) other unbiased sources; and
224          (g) other public health suicide prevention efforts.
225          (5) The coordinator shall provide a written report to the Health and Human Services
226     Interim Committee, at or before the October meeting every year, on:
227          (a) implementation of the state suicide prevention program, as described in Subsections
228     (1) and (3);
229          (b) data measuring the effectiveness of each component of the state suicide prevention
230     program;
231          (c) funds appropriated for each component of the state suicide prevention program; and
232          (d) five-year trends of suicides in Utah, including subgroups of youths and adults and
233     other subgroups identified by the state suicide prevention coordinator.
234          (6) The coordinator shall, in consultation with the bureau, implement and manage the
235     operation of the firearm safety program described in Subsection 62A-15-103(3).
236          (7) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
237     division shall make rules:
238          (a) governing the implementation of the state suicide prevention program, consistent
239     with this section; and
240          (b) in conjunction with the bureau, defining the criteria for employers to apply for
241     grants under the Suicide Prevention Education Program described in Section 62A-15-103.1,
242     which shall include:
243          (i) attendance at the suicide prevention education course described in Subsection
244     62A-15-103(3); and
245          (ii) distribution of the firearm safety brochures or packets created in Subsection
246     62A-15-103(3), but does not require the distribution of a cable-style gun lock with a firearm if
247     the firearm already has a trigger lock or comparable safety mechanism.
248          (8) As funding by the Legislature allows, the coordinator shall award grants, not to
249     exceed a total of $100,000 per fiscal year, to suicide prevention programs that focus on the
250     needs of children who have been served by the Division of Juvenile Justice Services.
251          (9) The coordinator and the coalition shall submit to the advisory council, no later than
252     October 1 each year, a written report detailing the previous fiscal year's activities to fund,
253     implement, and evaluate suicide prevention activities described in this section.
254          Section 4. Section 62A-15-1103 is amended to read:
255          62A-15-1103. Governor's Suicide Prevention Fund.
256          (1) There is created an expendable special revenue fund known as the Governor's
257     Suicide Prevention Fund.
258          (2) The fund shall consist of gifts, grants, and bequests of real property or personal
259     property made to the fund.
260          (3) A donor to the fund may designate a specific purpose for the use of the donor's
261     donation, if the designated purpose is described in Subsection (4) [or 62A-15-1101(3)].
262          (4) (a) Subject to Subsection (3), money in the fund shall be used for the following
263     activities:
264          [(a)] (i) efforts to directly improve mental health crisis response;
265          [(b)] (ii) efforts that directly reduce risk factors associated with suicide; and
266          [(c)] (iii) efforts that directly enhance known protective factors associated with suicide
267     reduction.
268          (b) Efforts described in Subsections (4)(a)(ii) and (iii) include the components of the
269     state suicide prevention program described in Subsection 62A-15-1101(3).
270          (5) The division shall establish a grant application and review process for the
271     expenditure of money from the fund.
272          (6) The grant application and review process shall describe:
273          (a) requirements to complete a grant application;
274          (b) requirements to receive funding;
275          (c) criteria for the approval of a grant application;
276          (d) standards for evaluating the effectiveness of a project proposed in a grant
277     application; and
278          (e) support offered by the division to complete a grant application.
279          (7) The division shall:
280          (a) review a grant application for completeness;
281          (b) make a recommendation to the governor or the governor's designee regarding a
282     grant application;
283          (c) send a grant application to the governor or the governor's designee for evaluation
284     and approval or rejection;
285          (d) inform a grant applicant of the governor or the governor's designee's determination
286     regarding the grant application; and
287          (e) direct the fund administrator to release funding for grant applications approved by
288     the governor or the governor's designee.
289          (8) The state treasurer shall invest the money in the fund under Title 51, Chapter 7,
290     State Money Management Act, except that all interest or other earnings derived from money in
291     the fund shall be deposited into the fund.
292          (9) Money in the fund may not be used for the Office of the Governor's administrative
293     expenses that are normally provided for by legislative appropriation.
294          (10) The governor or the governor's designee may authorize the expenditure of fund
295     money in accordance with this section.
296          (11) The governor shall make an annual report to the Legislature regarding the status of
297     the fund, including a report on the contributions received, expenditures made, and programs
298     and services funded.
299          Section 5. Section 63I-1-262 is amended to read:
300          63I-1-262. Repeal dates, Title 62A.
301          (1) Section 62A-3-209 is repealed July 1, 2023.
302          (2) Section 62A-4a-213 is repealed July 1, 2024.
303          (3) Sections 62A-5a-101, 62A-5a-102, 62A-5a-103, and 62A-5a-104, which create the
304     Coordinating Council for Persons with Disabilities, are repealed July 1, 2022.
305          [(4) Section 62A-15-114 is repealed December 31, 2021.]
306          [(5)] (4) Subsections 62A-15-116(1) and (5), the language that states "In consultation
307     with the Behavioral Health Crisis Response Commission, established in Section 63C-18-202,"
308     is repealed January 1, 2023.
309          [(6)] (5) Section 62A-15-118 is repealed December 31, 2023.
310          (6) Section 62A-15-124 is repealed December 31, 2024.
311          (7) Subsections 62A-15-605(3)(h) and (4) relating to the study of long-term needs for
312     adult beds in the state hospital are repealed July 1, 2022.
313          (8) Section 62A-15-605, which creates the Forensic Mental Health Coordinating
314     Council, is repealed July 1, 2023.
315          (9) Subsections 62A-15-1100(1) and 62A-15-1101(9), in relation to the Utah
316     Substance Use and Mental Health Advisory Council, are repealed January 1, 2023.
317          (10) In relation to the Behavioral Health Crisis Response Commission, on July 1, 2023:
318          (a) Subsections 62A-15-1301(2) and 62A-15-1401(1) are repealed;
319          (b) Subsection 62A-15-1302(1)(b), the language that states "and in consultation with
320     the commission" is repealed;
321          (c) Subsection 62A-15-1303(1), the language that states "In consultation with the
322     commission," is repealed;
323          (d) Subsection 62A-15-1402(2)(a), the language that states "With recommendations
324     from the commission," is repealed; and
325          (e) Subsection 62A-15-1702(6) is repealed.
326          Section 6. Appropriation.
327          The following sums of money are appropriated for the fiscal year beginning July 1,
328     2022, and ending June 30, 2023. These are additions to amounts previously appropriated for
329     fiscal year 2023. Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures
330     Act, the Legislature appropriates the following sums of money from the funds or accounts
331     indicated for the use and support of the government of the state of Utah.
332     ITEM 1
333          To Department of Health and Human Services -- Health Care Administration
334               From General Fund, One-time
$1,000,000

335               Schedule of Programs:
336                    Integrated Health Care Administration          $1,000,000
337          The Legislature intends that:
338          (1) the appropriations under this item be used for the collaborative care grant program
339     under Section 62A-15-124; and
340          (2) under Section 63J-1-603, the appropriations under this item not lapse at the close of
341     fiscal year 2023 and the use of any nonlapsing funds is limited to the purpose described in
342     Subsection (1) of this item.
343     ITEM 2
344          To Department of Health and Human Services -- Integrated Health Care Services
345               From General Fund
$350,000

346               From General Fund, One-time
$2,430,000

347               Schedule of Programs:
348                    Non-Medicaid Behavioral Health Treatment
349                    and Crisis Response                         $2,780,000
350          The Legislature intends that:
351          (1) the appropriations under this item be used for the state suicide prevention program
352     described in Section 62A-15-1101; and
353          (2) under Section 63J-1-603, the appropriations under this item not lapse at the close of
354     fiscal year 2023 and the use of any nonlapsing funds is limited to the purpose described in
355     Subsection (1) of this item.
356          Section 7. Effective date.
357          This bill takes effect on May 4, 2022, except that Section 26-18-405.5 (Effective
358     07/01/22) takes effect on July 1, 2022.