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<leg xml:space="preserve" filenumber="2024FL0795" billnumber="SB0197" billnum="SB0197" designation="SB" otherSponsor="Stephanie Gricius" otherHouse="House" sess="2024GS" fileno="2024FL0795" date="03-06-24" printDate="06-19 07:34" subVer="-2" minVer="1" office="LEGISLATIVE GENERAL COUNSEL" actionDate="" impact="code" track=" " sponsor="Todd D. Weiler">
  <info>
    <nextbuid>3</nextbuid>
    <aminfo anum="0" effdate="5/1/2024" datetype="most">
      <seclist>
        <sect uid="C26B-3-S203_2024050120240501" fromuid="C26B-3-S203_2023050320230503" buid="1" src="code" mtype="section" action="A" sort="26B03 02030020240501" effdate="5/1/2024">26B-3-203</sect>
        <sect uid="EF0000" buid="2" src="uncod" untype="effdate" mtype="section" sort="UZEFF" effdate="5/1/2024"/>
      </seclist>
    </aminfo>
  </info>
  <tbox>
    <sinfo/>
    <st numlevel="1" lineno="1" slineno="0-1">MEDICAID REIMBURSEMENT RATE AMENDMENTS</st>
    <sessionhead>2024 GENERAL SESSION</sessionhead>
    <statehead>STATE OF UTAH</statehead>
    <sponsorhead>Chief Sponsor: Todd D. Weiler</sponsorhead>
    <otherSponsorhead>House Sponsor: Stephanie Gricius</otherSponsorhead>
  </tbox>
  <lt numlevel="1" lineno="2" slineno="0-2">
    <lthead lineno="3">LONG TITLE</lthead>
    <gdhead lineno="4">General Description:</gdhead>
    <gd numlevel="1" lineno="5" slineno="0-5">This bill addresses Medicaid reimbursement rates.</gd>
    <hphead lineno="6">Highlighted Provisions:</hphead>
    <hp numlevel="1" lineno="7" slineno="0-7">This bill:
      <hl numlevel="1" lineno="8" slineno="0-8" level="1">defines terms; and</hl>
      <hl numlevel="1" lineno="9" slineno="0-9" level="1">establishes a budgeting mechanism under which Medicaid reimbursement rates for  
        <ln numlevel="1" lineno="10" slineno="0-10"/>applied behavior analysis may increase. 
      </hl>
    </hp>
    <moni numlevel="1" lineno="11" slineno="0-11" display="none">Money Appropriated in this Bill:</moni>
    <moniNone lineno="12">None</moniNone>
    <oc numlevel="1" lineno="13" slineno="0-13">Other Special Clauses:</oc>
    <ocNone lineno="14">None</ocNone>
    <sa numlevel="1" lineno="15" slineno="0-15">Utah Code Sections Affected:
      <saamd numlevel="1" lineno="16" slineno="0-16">
        <snhead>AMENDS:</snhead>
        <sn num="26B-3-203" src="code" uid="C26B-3-S203_2024050120240501" buid="1" sort="26B03 02030020240501" numlevel="1" lineno="17" slineno="0-17">
          <bold>26B-3-203</bold>, as renumbered and amended by Laws of Utah 2023, Chapter 306
        </sn>
      </saamd>
    </sa>
  </lt>
  <enacthead lineno="18"/>
  <enact numlevel="1" lineno="19" slineno="0-19">Be it enacted by the Legislature of the state of Utah:</enact>
  <bdy>
    <bsec buid="1" type="amend" src="code" num="26B-3-203" uid="C26B-3-S203_2024050120240501" sort="26B03 02030020240501" fromUID="C26B-3-S203_2023050320230503" numlevel="1" lineno="20" slineno="1-1" sn="1">
      <section number="26B-3-203" numlevel="1" lineno="21" slineno="1-2" type="amend">
        <secline lineno="20">Section 1, Section  
          <bold>26B-3-203</bold> is amended to read:
        </secline>
        <catline lineno="21">
          <bold>26B-3-203. Base budget appropriations for Medicaid accountable care  
            <ln numlevel="1" lineno="22" slineno="1-3"/>organizations, behavioral health plans, and ABA services -- Forecast of behavioral health  
            <ln numlevel="1" lineno="23" slineno="1-4"/>services cost.
          </bold>
        </catline>
        <subsection ssid="1-1" dnum="1-o" numlevel="1" lineno="24" slineno="1-5" placement="noreturn">
          <display>(1)</display>As used in this section:
          <subsection ssid="1-2" dnum="_-o:a-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="25" slineno="1-6">
            <display>
              <amend anum="0" ea="amend" pairid="30" style="1" owner="e" level="1" amendtag="start">(a)</amend>
            </display>
            <amend anum="0" ea="amend" pairid="2" style="1" owner="ggunn" level="1" amendtag="end">"ABA service" means a service applying applied behavior analysis, as that term is  
              <ln numlevel="1" lineno="26" slineno="1-7"/>defined in Section  
              <xref depth="3" refnumber="31A-22-642">31A-22-642</xref>.
            </amend>
          </subsection>
          <subsection ssid="1-3" dnum="_-o:b-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="27" slineno="1-8">
            <display>
              <amend anum="0" ea="amend" pairid="31" style="1" owner="e" level="1" amendtag="start">(b)</amend>
            </display>
            <amend anum="0" ea="amend" pairid="5" style="1" owner="ggunn" level="1" amendtag="end">"ABA service reimbursement rate" means the Medicaid reimbursement rate  
              <ln numlevel="1" lineno="28" slineno="1-9"/>developed by the division, in accordance with Part 1, Health Care Assistance, and  
              <ln numlevel="1" lineno="29" slineno="1-10"/>paid to a provider for providing an ABA service.
            </amend>
          </subsection>
          <subsection ssid="1-4" dnum="a-o:c-e" numlevel="1" lineno="30" slineno="1-11">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="32" style="2" owner="o" level="1" deltag="both">(a)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="33" style="1" owner="e" level="1" amendtag="both" space="true">(c)</amend>
            </display>"ACO" means an accountable care organization that contracts with the state's  
            <ln numlevel="1" lineno="31" slineno="1-12"/>Medicaid program for:
            <subsection ssid="1-5" dnum="i-o" numlevel="1" lineno="32" slineno="1-13">
              <display>(i)</display>physical health services; or
            </subsection>
            <subsection ssid="1-6" dnum="ii-o" numlevel="1" lineno="33" slineno="1-14">
              <display>(ii)</display>integrated physical and behavioral health services.
            </subsection>
          </subsection>
          <subsection ssid="1-7" dnum="b-o:d-e" numlevel="1" lineno="34" slineno="1-15">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="35" style="2" owner="o" level="1" deltag="both">(b)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="36" style="1" owner="e" level="1" amendtag="both" space="true">(d)</amend>
            </display>"Base budget" means the same as that term is defined in legislative rule.
          </subsection>
          <subsection ssid="1-8" dnum="c-o:e-e" numlevel="1" lineno="35" slineno="1-16">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="36" style="2" owner="o" level="1" deltag="both">(c)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="37" style="1" owner="e" level="1" amendtag="both" space="true">(e)</amend>
            </display>"Behavioral health plan" means a managed care or fee for service delivery  
            <ln numlevel="1" lineno="36" slineno="1-17"/>system that contracts with or is operated by the department to provide behavioral  
            <ln numlevel="1" lineno="37" slineno="1-18"/>health services to Medicaid eligible individuals.
          </subsection>
          <subsection ssid="1-9" dnum="d-o:f-e" numlevel="1" lineno="38" slineno="1-19">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="37" style="2" owner="o" level="1" deltag="both">(d)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="38" style="1" owner="e" level="1" amendtag="both" space="true">(f)</amend>
            </display>"Behavioral health services" means mental health or substance use treatment or  
            <ln numlevel="1" lineno="39" slineno="1-20"/>services.
          </subsection>
          <subsection ssid="1-10" dnum="e-o:g-e" numlevel="1" lineno="40" slineno="1-21">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="38" style="2" owner="o" level="1" deltag="both">(e)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="39" style="1" owner="e" level="1" amendtag="both" space="true">(g)</amend>
            </display>"General Fund growth factor" means the amount determined by dividing the  
            <ln numlevel="1" lineno="41" slineno="1-22"/>next fiscal year ongoing General Fund revenue estimate by current fiscal year  
            <ln numlevel="1" lineno="42" slineno="1-23"/>ongoing appropriations from the General Fund.
          </subsection>
          <subsection ssid="1-11" dnum="f-o:h-e" numlevel="1" lineno="43" slineno="1-24">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="39" style="2" owner="o" level="1" deltag="both">(f)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="40" style="1" owner="e" level="1" amendtag="both" space="true">(h)</amend>
            </display>"Next fiscal year ongoing General Fund revenue estimate" means the next fiscal  
            <ln numlevel="1" lineno="44" slineno="1-25"/>year ongoing General Fund revenue estimate identified by the Executive  
            <ln numlevel="1" lineno="45" slineno="1-26"/>Appropriations Committee, in accordance with legislative rule, for use by the Office  
            <ln numlevel="1" lineno="46" slineno="1-27"/>of the Legislative Fiscal Analyst in preparing budget recommendations.
          </subsection>
          <subsection ssid="1-12" dnum="g-o:i-e" numlevel="1" lineno="47" slineno="1-28">
            <display>
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="40" style="2" owner="o" level="1" deltag="both">(g)</amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="41" style="1" owner="e" level="1" amendtag="both" space="true">(i)</amend>
            </display>"PMPM" means per-member-per-month funding.
          </subsection>
        </subsection>
        <subsection ssid="1-13" dnum="2-o" numlevel="1" lineno="48" slineno="1-29">
          <display>(2)</display>If the General Fund growth factor is less than 100%, the next fiscal year base budget  
          <ln numlevel="1" lineno="49" slineno="1-30"/>shall, subject to Subsection (5), include an appropriation to the department in an amount  
          <ln numlevel="1" lineno="50" slineno="1-31"/>necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health  
          <ln numlevel="1" lineno="51" slineno="1-32"/>plans equals the current fiscal year PMPM for the ACOs and behavioral health plans  
          <ln numlevel="1" lineno="52" slineno="1-33"/>multiplied by 100%.
        </subsection>
        <subsection ssid="1-14" dnum="3-o" numlevel="1" lineno="53" slineno="1-34">
          <display>(3)</display>If the General Fund growth factor is greater than or equal to 100%, but less than 102%,  
          <ln numlevel="1" lineno="54" slineno="1-35"/>the next fiscal year base budget shall, subject to Subsection (5), include an appropriation  
          <ln numlevel="1" lineno="55" slineno="1-36"/>to the department in an amount necessary to ensure that the next fiscal year PMPM for  
          <ln numlevel="1" lineno="56" slineno="1-37"/>ACOs and behavioral health plans equals the current fiscal year PMPM for the ACOs  
          <ln numlevel="1" lineno="57" slineno="1-38"/>and behavioral health plans multiplied by the General Fund growth factor.
        </subsection>
        <subsection ssid="1-15" dnum="4-o" numlevel="1" lineno="58" slineno="1-39">
          <display>(4)</display>If the General Fund growth factor is greater than or equal to 102%, the next fiscal year  
          <ln numlevel="1" lineno="59" slineno="1-40"/>base budget shall, subject to Subsection (5)
          <amendoutstart style="5"/>
          <amend anum="0" ea="erase" pairid="7" style="2" owner="ggunn" level="1" deltag="both">, </amend>
          <amendoutend style="5"/>
          <amend anum="0" ea="amend" pairid="8" style="1" owner="ggunn" level="1" amendtag="both" space="true">:</amend>
          <subsection ssid="1-16" dnum="_-o:a-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="60" slineno="1-41">
            <display>
              <amend anum="0" ea="amend" pairid="44" style="1" owner="e" level="1" amendtag="start">(a)</amend>
            </display>
            <amend anum="0" ea="amend" pairid="10" style="1" owner="ggunn" level="1" amendtag="end">in fiscal years 2025 and 2026:</amend>
            <subsection ssid="1-17" dnum="_-o:i-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="61" slineno="1-42">
              <display>
                <amend anum="0" ea="amend" pairid="45" style="1" owner="e" level="1" amendtag="both">(i)</amend>
              </display>include an appropriation to the department in an amount  
              <amendoutstart style="5"/>
              <amend anum="0" ea="erase" pairid="12" style="2" owner="ggunn" level="1" deltag="both">necessary to ensure that  
                <ln numlevel="1" lineno="62" slineno="1-43"/>the next fiscal year PMPM for ACOs and behavioral health plans is greater than or  
                <ln numlevel="1" lineno="63" slineno="1-44"/>equal to the current fiscal year PMPM for the ACOs and behavioral health plans  
                <ln numlevel="1" lineno="64" slineno="1-45"/>multiplied by 102% and less than or equal to the current fiscal year PMPM for the  
                <ln numlevel="1" lineno="65" slineno="1-46"/>ACOs and behavioral health plans multiplied by the General Fund growth factor.
              </amend>
              <amendoutend style="5"/>
              <amend anum="0" ea="amend" pairid="13" style="1" owner="ggunn" level="1" amendtag="both" space="true">
                <ln numlevel="1" lineno="66" slineno="1-47"/>that would, prior to the application of Subsection 
                <xref tempid="259">(4)(a)(ii)</xref>, allow the department 
                <ln numlevel="1" lineno="67" slineno="1-48"/>to ensure that the next fiscal year PMPMs for ACOs and behavioral health plans is 
                <ln numlevel="1" lineno="68" slineno="1-49"/>greater than or equal to the current fiscal year PMPMs for the ACOs and 
                <ln numlevel="1" lineno="69" slineno="1-50"/>behavioral health plans multiplied by 102%;
              </amend>
            </subsection>
            <subsection ssid="1-18" dnum="_-o:ii-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="70" slineno="1-51">
              <display>
                <amend anum="0" ea="amend" pairid="46" style="1" owner="e" level="1" amendtag="start">(ii)</amend>
              </display>
              <amend anum="0" ea="amend" pairid="16" style="1" owner="ggunn" level="1" amendtag="end">subject to Subsection (4)(a)(iii), allocate the amount appropriated under  
                <ln numlevel="1" lineno="71" slineno="1-52"/>Subsection  
                <xref tempid="356">(4)(a)(i)</xref> to provide substantially the same year-over-year percentage  
                <ln numlevel="1" lineno="72" slineno="1-53"/>point increase to:
              </amend>
              <subsection ssid="1-19" dnum="_-o:A-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="73" slineno="1-54">
                <display>
                  <amend anum="0" ea="amend" pairid="47" style="1" owner="e" level="1" amendtag="start">(A)</amend>
                </display>
                <amend anum="0" ea="amend" pairid="18" style="1" owner="ggunn" level="1" amendtag="end">the PMPMs for ACOs and behavioral health plans; and</amend>
              </subsection>
              <subsection ssid="1-20" dnum="_-o:B-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="74" slineno="1-55">
                <display>
                  <amend anum="0" ea="amend" pairid="48" style="1" owner="e" level="1" amendtag="start">(B)</amend>
                </display>
                <amend anum="0" ea="amend" pairid="21" style="1" owner="ggunn" level="1" amendtag="end">each ABA service reimbursement rate; and</amend>
              </subsection>
            </subsection>
            <subsection ssid="1-21" dnum="_-o:iii-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="75" slineno="1-56">
              <display>
                <amend anum="0" ea="amend" pairid="49" style="1" owner="e" level="1" amendtag="start">(iii)</amend>
              </display>
              <amend anum="0" ea="amend" pairid="25" style="1" owner="ggunn" level="1" amendtag="end">for the initial appropriation under Subsection (4)(a)(i), prior to providing the  
                <ln numlevel="1" lineno="76" slineno="1-57"/>percentage point increases under Subsection (4)(a)(ii), allocate from the total  
                <ln numlevel="1" lineno="77" slineno="1-58"/>amount appropriated under Subsection (4)(a)(i) an amount necessary to increase  
                <ln numlevel="1" lineno="78" slineno="1-59"/>and substantially equalize each of the ABA service reimbursement rates with a  
                <ln numlevel="1" lineno="79" slineno="1-60"/>corresponding reimbursement rate paid for providing the same or substantially  
                <ln numlevel="1" lineno="80" slineno="1-61"/>similar service under an ACO or a behavioral health plan; and
              </amend>
            </subsection>
          </subsection>
          <subsection ssid="1-22" dnum="_-o:b-e" ea="amend" anum="0" owner="ggunn" style="1" numlevel="1" lineno="81" slineno="1-62">
            <display>
              <amend anum="0" ea="amend" pairid="50" style="1" owner="e" level="1" amendtag="start">(b)</amend>
            </display>
            <amend anum="0" ea="amend" pairid="29" style="1" owner="ggunn" level="1" amendtag="end">beginning in fiscal year 2027, include an appropriation to the department in an  
              <ln numlevel="1" lineno="82" slineno="1-63"/>amount necessary to ensure that the next fiscal year PMPMs for ACOs and  
              <ln numlevel="1" lineno="83" slineno="1-64"/>behavioral health plans is greater than or equal to the current fiscal year PMPMs for  
              <ln numlevel="1" lineno="84" slineno="1-65"/>the ACOs and the behavioral health plans multiplied by 102%, and less than or equal  
              <ln numlevel="1" lineno="85" slineno="1-66"/>to the current fiscal year PMPMs for the ACOs and the behavioral health plans  
              <ln numlevel="1" lineno="86" slineno="1-67"/>multiplied by the General Fund growth factor.
            </amend>
          </subsection>
        </subsection>
        <subsection ssid="1-23" dnum="5-o" numlevel="1" lineno="87" slineno="1-68">
          <display>(5)</display>The appropriations provided to the department for behavioral health plans under this  
          <ln numlevel="1" lineno="88" slineno="1-69"/>section shall be reduced by the amount contributed by counties in the current fiscal year  
          <ln numlevel="1" lineno="89" slineno="1-70"/>for behavioral health plans in accordance with Subsections  
          <xref depth="3" refnumber="17-43-201">17-43-201</xref>(5)(k) and  
          <xref depth="3" refnumber="17-43-301">
            <ln numlevel="1" lineno="90" slineno="1-71"/>17-43-301
          </xref>(6)(a)(x).
        </subsection>
        <subsection ssid="1-24" dnum="6-o" numlevel="1" lineno="91" slineno="1-72">
          <display>(6)</display>In order for the department to estimate the impact of Subsections (2) through (4) before  
          <ln numlevel="1" lineno="92" slineno="1-73"/>identification of the next fiscal year ongoing General Fund revenue estimate, the  
          <ln numlevel="1" lineno="93" slineno="1-74"/>Governor's Office of Planning and Budget shall, in cooperation with the Office of the  
          <ln numlevel="1" lineno="94" slineno="1-75"/>Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the  
          <ln numlevel="1" lineno="95" slineno="1-76"/>next fiscal year and provide the estimate to the department no later than November 1 of  
          <ln numlevel="1" lineno="96" slineno="1-77"/>each year.
        </subsection>
        <subsection ssid="1-25" dnum="7-o" numlevel="1" lineno="97" slineno="1-78">
          <display>(7)</display>The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of  
          <ln numlevel="1" lineno="98" slineno="1-79"/>behavioral health services in any state Medicaid funding or savings forecast that is  
          <ln numlevel="1" lineno="99" slineno="1-80"/>completed in coordination with the department and the Governor's Office of Planning  
          <ln numlevel="1" lineno="100" slineno="1-81"/>and Budget.
        </subsection>
      </section>
    </bsec>
    <bsec buid="2" type="uncod" untype="effdate" src="uncod" uid="EF0000" sort="UZEFF" numlevel="1" lineno="101" slineno="2-1" sn="2">
      <section type="uncod" untype="effdate" display="false" src="uncod">
        <secline lineno="101">Section 2.   
          <bold>Effective date.</bold>
        </secline>
        <sectionText lineno="102">
          <amend anum="0" ea="amend" pairid="1" style="1" owner="ggunn" level="1" amendtag="both">
            <tab/>This bill takes effect on May 1, 2024.
          </amend>
        </sectionText>
      </section>
    </bsec>
  </bdy>
  <foot>
    <rev/>
  </foot>
</leg>

