Representative Stephanie Gricius proposes the following substitute bill:


1     
MEDICAID REIMBURSEMENT RATE AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Todd D. Weiler

5     
House Sponsor: Stephanie Gricius

6     

7     LONG TITLE
8     General Description:
9          This bill addresses Medicaid reimbursement rates.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms; and
13          ▸     establishes a budgeting mechanism under which Medicaid reimbursement rates for
14     applied behavior analysis may increase.
15     Money Appropriated in this Bill:
16          None
17     Other Special Clauses:
18          None
19     Utah Code Sections Affected:
20     AMENDS:
21          26B-3-203, as renumbered and amended by Laws of Utah 2023, Chapter 306
22     

23     Be it enacted by the Legislature of the state of Utah:
24          Section 1. Section 26B-3-203 is amended to read:
25          26B-3-203. Base budget appropriations for Medicaid accountable care
26     organizations, behavioral health plans, and ABA services -- Forecast of behavioral health
27     services cost.
28          (1) As used in this section:
29          (a) "ABA service" means a service applying applied behavior analysis, as that term is
30     defined in Section 31A-22-642.
31          (b) "ABA service reimbursement rate" means the Medicaid reimbursement rate
32     developed by the division, in accordance with Part 1, Health Care Assistance, and paid to a
33     provider for providing an ABA service.
34          [(a)] (c) "ACO" means an accountable care organization that contracts with the state's
35     Medicaid program for:
36          (i) physical health services; or
37          (ii) integrated physical and behavioral health services.
38          [(b)] (d) "Base budget" means the same as that term is defined in legislative rule.
39          [(c)] (e) "Behavioral health plan" means a managed care or fee for service delivery
40     system that contracts with or is operated by the department to provide behavioral health
41     services to Medicaid eligible individuals.
42          [(d)] (f) "Behavioral health services" means mental health or substance use treatment
43     or services.
44          [(e)] (g) "General Fund growth factor" means the amount determined by dividing the
45     next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
46     appropriations from the General Fund.
47          [(f)] (h) "Next fiscal year ongoing General Fund revenue estimate" means the next
48     fiscal year ongoing General Fund revenue estimate identified by the Executive Appropriations
49     Committee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal
50     Analyst in preparing budget recommendations.
51          [(g)] (i) "PMPM" means per-member-per-month funding.
52          (2) If the General Fund growth factor is less than 100%, the next fiscal year base
53     budget shall, subject to Subsection (5), include an appropriation to the department in an
54     amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
55     plans equals the current fiscal year PMPM for the ACOs and behavioral health plans multiplied
56     by 100%.
57          (3) If the General Fund growth factor is greater than or equal to 100%, but less than
58     102%, the next fiscal year base budget shall, subject to Subsection (5), include an appropriation
59     to the department in an amount necessary to ensure that the next fiscal year PMPM for ACOs
60     and behavioral health plans equals the current fiscal year PMPM for the ACOs and behavioral
61     health plans multiplied by the General Fund growth factor.
62          (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal
63     year base budget shall, subject to Subsection (5)[,]:
64          (a) include an appropriation to the department in an amount [necessary to ensure that
65     the next fiscal year PMPM for ACOs and behavioral health plans is greater than or equal to the
66     current fiscal year PMPM for the ACOs and behavioral health plans multiplied by 102% and
67     less than or equal to the current fiscal year PMPM for the ACOs and behavioral health plans
68     multiplied by the General Fund growth factor.] that would, prior to the application of
69     Subsection (4)(b), allow the department to ensure that the next fiscal year PMPMs for ACOs
70     and behavioral health plans is greater than or equal to the current fiscal year PMPMs for the
71     ACOs and behavioral health plans multiplied by 102%;
72          (b) subject to Subsection (4)(c), allocate the amount appropriated under Subsection
73     (4)(a) to provide substantially the same year-over-year percentage point increase to:
74          (i) the PMPMs for ACOs and behavioral health plans; and
75          (ii) each ABA service reimbursement rate; and
76          (c) for the initial appropriation under Subsection (4)(b), prior to providing the
77     percentage point increases under Subsection (4)(b), allocate from the total amount appropriated
78     under Subsection (4)(a) an amount necessary to increase and substantially equalize each of the
79     ABA service reimbursement rates with a corresponding reimbursement rate paid for providing
80     the same or substantially similar service under an ACO or a behavioral health plan.
81          (5) The appropriations provided to the department for behavioral health plans under
82     this section shall be reduced by the amount contributed by counties in the current fiscal year for
83     behavioral health plans in accordance with Subsections 17-43-201(5)(k) and
84     17-43-301(6)(a)(x).
85          (6) In order for the department to estimate the impact of Subsections (2) through (4)
86     before identification of the next fiscal year ongoing General Fund revenue estimate, the
87     Governor's Office of Planning and Budget shall, in cooperation with the Office of the
88     Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next
89     fiscal year and provide the estimate to the department no later than November 1 of each year.
90          (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
91     behavioral health services in any state Medicaid funding or savings forecast that is completed
92     in coordination with the department and the Governor's Office of Planning and Budget.
93          Section 2. Effective date.
94          This bill takes effect on May 1, 2024.