Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 154 First Substitute (2016GS)

Sponsor

Sen. Adams, J. S.

Final action

Governor Signed 3/29/2016

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines terms; and
• includes the cost of a mandated Medicaid program change in the baseline Medicaid accountable care organization funding for a certain period of time.

Every vote on this bill

Bill text

MEDICAID ACCOUNTABLE CARE ORGANIZATIONS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: J. Stuart Adams
House Sponsor: 
____________
LONG TITLE
General Description:
This bill amends the Medical Assistance Programs of the Utah Health Code.
Highlighted Provisions:
This bill:
▸ defines terms; and
▸ includes the cost of a mandated Medicaid program change in the baseline Medicaid
accountable care organization funding for a certain period of time.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26-18-405
, as enacted by Laws of Utah 2011, Chapter 211
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-405
 is amended to read:
26-18-405.
Waivers to maximize replacement of fee-for-service delivery model --
Cost of mandated program changes.
(1) The department shall develop a proposal to amend the state plan for the Medicaid
program in a way that maximizes replacement of the fee-for-service delivery model with one or
more risk-based delivery models.
(2) The proposal shall:
(a) restructure the program's provider payment provisions to reward health care
providers for delivering the most appropriate services at the lowest cost and in ways that,
compared to services delivered before implementation of the proposal, maintain or improve
recipient health status;
(b) restructure the program's cost sharing provisions and other incentives to reward
recipients for personal efforts to:
(i) maintain or improve their health status; and
(ii) use providers that deliver the most appropriate services at the lowest cost;
(c) identify the evidence-based practices and measures, risk adjustment methodologies,
payment systems, funding sources, and other mechanisms necessary to reward providers for
delivering the most appropriate services at the lowest cost, including mechanisms that:
(i) pay providers for packages of services delivered over entire episodes of illness
rather than for individual services delivered during each patient encounter; and
(ii) reward providers for delivering services that make the most positive contribution to
a recipient's health status;
(d) limit total annual per-patient-per-month expenditures for services delivered through
fee-for-service arrangements to total annual per-patient-per-month expenditures for services
delivered through risk-based arrangements covering similar recipient populations and services;
and
(e) 
except as provided in Subsection (4),
 limit the rate of growth in
per-patient-per-month General Fund expenditures for the program to the rate of growth in
General Fund expenditures for all other programs, when the rate of growth in the General Fund
expenditures for all other programs is greater than zero.
(3) To the extent possible, the department shall develop the proposal with the input of
stakeholder groups representing those who will be affected by the proposal.
[
(4) No later than June 1, 2011, the department shall submit a written report on the
development of the proposal to the Legislature's Executive Appropriations Committee, Social
Services Appropriations Subcommittee, and Health and Human Services Interim Committee.
]
[
(5) No later than July 1, 2011, the department shall submit to the Centers for Medicare
and Medicaid Services within the United States Department of Health and Human Services a
request for waivers from federal statutory and regulatory law necessary to implement the
proposal.
]
[
(6) After the request for waivers has been made, and prior to its implementation, the
department shall report to the Legislature in accordance with Section 
26-18-3
 on any
modifications to the request proposed by the department or made by the Centers for Medicare
and Medicaid Services.
]
[
(7) The department shall implement the proposal in the fiscal year that follows the
fiscal year in which the United States Secretary of Health and Human Services approves the
request for waivers.
]
(4) (a) For purposes of this Subsection (4), "mandated program change" means a
change to the state Medicaid program that is required by federal or state law.
(b) A mandated program change shall be included in the baseline funding for the
Medicaid program during the first fiscal year following the year in which the Medicaid
program adopts the mandated program change.
(c) The mandated program change is not subject to the limit on the rate of growth in
per-patient-per-month General Fund expenditures for the program established in Subsection
(2)(e), until after the budget year designated in Subsection (4)(b).
Legislative Review Note
Office of Legislative Research and General Counsel