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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
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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.
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35 Medicaid program for:
36 (i) physical health services; or
37 (ii) integrated physical and behavioral health services.
38 [
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40 system that contracts with or is operated by the department to provide behavioral health
41 services to Medicaid eligible individuals.
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43 or services.
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45 next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
46 appropriations from the General Fund.
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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.
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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 [
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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.