Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 161 Sixth Substitute (2021GS)

Sponsor

Sen. Weiler, T.

Final action

Governor Signed 3/22/2021

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• creates, modifies, and repeals definitions;
• requires the base budget to include certain appropriations to the Department of Health and the Department of Human Services for insurance plans that contract with the state's Medicaid program for behavioral health services;
• requires a health benefit plan to:
• provide coverage for treatment of a mental health condition through telemedicine services if certain conditions are met; and
• reimburse for the treatment at a certain rate;
• allows a provider to use any synchronous audiovisual technology that is compliant with the federal Health Insurance Portability and Accountability Act of 1996 for certain treatment through telemedicine services;
• prohibits the Division of Occupational and Professional Licensing from refusing to issue, or taking disciplinary action against, the occupational license of certain health care providers based solely on the provider seeking or participating in mental health or substance abuse treatment; and
• makes technical and conforming changes.

Every vote on this bill

Bill text

MENTAL HEALTH SYSTEMS AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Todd D. Weiler
House Sponsor: 
Steve Eliason
LONG TITLE
General Description:
This bill addresses mental and behavioral health services in the state.
Highlighted Provisions:
This bill:
▸ creates, modifies, and repeals definitions;
▸ requires the base budget to include certain appropriations to the Department of
Health and the Department of Human Services for insurance plans that contract
with the state's Medicaid program for behavioral health services;
▸ requires a health benefit plan to:
• provide coverage for treatment of a mental health condition through
telemedicine services if certain conditions are met; and
• reimburse for the treatment at a certain rate;
▸ allows a provider to use any synchronous audiovisual technology that is compliant
with the federal Health Insurance Portability and Accountability Act of 1996 for
certain treatment through telemedicine services;
▸ prohibits the Division of Occupational and Professional Licensing from refusing to
issue, or taking disciplinary action against, the occupational license of certain health
care providers based solely on the provider seeking or participating in mental health
or substance abuse treatment; and
▸ makes technical and conforming changes.
Money Appropriated in this Bill:
This bill appropriates in fiscal year 2022:
▸ to Department of Health -- Medicaid Services, as an ongoing appropriation:
• From Federal Funds, $3,780,000;
• From Expendable Receipts, $340,000; and
• From Medicaid Expansion Fund, $36,000;
▸ to Department of Health -- Medicaid Services, as a one-time appropriation:
• From Federal Funds, One-time, ($2,950,000);
• From Expendable Receipts, One-time, ($260,000); and
• From Medicaid Expansion Fund, One-time, ($26,000);
▸ to Department of Human Services -- Division of Substance Abuse and Mental
Health, as an ongoing appropriation:
• From General Fund, $1,369,100; and
▸ to Department of Human Services -- Division of Substance Abuse and Mental
Health, as a one-time appropriation:
• From General Fund, One-time, ($1,066,500).
Other Special Clauses:
This bill provides a special effective date.
This bill provides a coordination clause.
Utah Code Sections Affected:
AMENDS:
26-18-405.5
, as enacted by Laws of Utah 2015, Chapter 288
31A-22-649.5
, as enacted by Laws of Utah 2020, Chapter 119
58-1-401
, as last amended by Laws of Utah 2020, Chapter 289
58-31b-401
, as last amended by Laws of Utah 2019, Chapter 136
58-60-108
, as enacted by Laws of Utah 1994, Chapter 32
58-61-401
, as enacted by Laws of Utah 1994, Chapter 32
58-67-401
, as last amended by Laws of Utah 2011, Chapter 214
58-68-401
, as last amended by Laws of Utah 2011, Chapter 214
58-70a-401
, as enacted by Laws of Utah 1997, Chapter 229
ENACTS:
58-81-105
, Utah Code Annotated 1953
Utah Code Sections Affected by Coordination Clause:
31A-22-649.5
, as enacted by Laws of Utah 2020, Chapter 119
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-405.5
 is amended to read:
26-18-405.5.
Base budget appropriations for Medicaid accountable care
organizations and mental health plans.
(1) [
For purposes of
] 
As used in
 this section:
(a) [
"ACOs" means accountable care organizations.
] 
"ACO" means an accountable
care organization that contracts with the state's Medicaid program for:
(i) physical health services; or
(ii) integrated physical and behavioral health services.
(b) "Base budget" means the same as that term is defined in legislative rule.
[
(c) "Current fiscal year PMPM" means per-member-per-month funding for Medicaid
accountable care organizations under the Department of Health in the current fiscal year.
]
[
(d)
] 
(c)
 "General Fund growth factor" means the amount determined by dividing the
next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
appropriations from the General Fund.
(d) "Mental health plan" means a prepaid mental health plan or a health plan that uses a
fee-for-service payment model that contracts with the state's Medicaid program for behavioral
health services.
(e) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal
year ongoing General Fund revenue estimate identified by the Executive Appropriations
Subcommittee, in accordance with legislative rule, for use by the Office of the Legislative
Fiscal Analyst in preparing budget recommendations.
[
(f) "Next fiscal year PMPM" means per-member-per-month funding for Medicaid
accountable care organizations under the Department of Health for the next fiscal year.
]
(f) "PMPM" means per-member-per-month funding.
(2) If the General Fund growth factor is less than 100%, the next fiscal year base
budget shall include an appropriation
:
(a)
 to the [
Department of Health for Medicaid
] 
department for
 ACOs 
under the
department
 in an amount necessary to ensure that 
the
 next fiscal year PMPM 
for the ACOs
equals 
the
 current fiscal year PMPM 
for the ACOs
 multiplied by 100%[
.
]
; and
(b) subject to Subsection (5), to the Department of Human Services for mental health
plans under the Department of Human Services in an amount necessary to ensure that the
funding for the mental health plans in the next fiscal year equals the funding for the mental
health plans in the current fiscal year multiplied by 100%.
(3) If the General Fund growth factor is greater than or equal to 100%, but less than
102%, the next fiscal year base budget shall include an appropriation
:
(a)
 to the [
Department of Health for Medicaid
] 
department for
 ACOs 
under the
department
 in an amount necessary to ensure that 
the
 next fiscal year PMPM 
for the ACOs
equals 
the
 current fiscal year PMPM 
for the ACOs
 multiplied by the General Fund growth
factor[
.
]
; and
(b) subject to Subsection (5), to the Department of Human Services for mental health
plans under the Department of Human Services in an amount necessary to ensure that the
funding for the mental health plans in the next fiscal year equals the funding for the mental
health plans in the current fiscal year multiplied by the General Fund growth factor.
(4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal
year base budget shall include an appropriation
:
(a)
 to the [
Department of Health for Medicaid
] 
department for
 ACOs 
under the
department
 in an amount necessary to ensure that 
the
 next fiscal year PMPM 
for the ACOs
 is
greater than or equal to 
the current fiscal year
 PMPM 
for the ACOs
 multiplied by 102% and
less than or equal to 
the
 current fiscal year PMPM 
for the ACOs
 multiplied by the General
Fund growth factor[
.
]
; and
(b) subject to Subsection (5), to the Department of Human Services for mental health
plans under the Department of Human Services in an amount necessary to ensure that the
funding for the mental health plans in the next fiscal year is greater than or equal to the funding
for the mental health plans in the current fiscal year multiplied by 102% and less than or equal
to the funding for the mental health plans in the current fiscal year multiplied by the General
Fund growth factor.
(5) The appropriations provided to the Department of Human Services under this
section shall be reduced by the amount contributed by counties in the current fiscal year for
mental health plans under the Department of Human Services in accordance with Subsections
17-43-201
(5)(k) and 
17-43-301
(6)(a)(x).
[
(5)
] 
(6)
 In order for the department 
and the Department of Human Services
 to estimate
the impact of Subsections (2) through (4) [
prior to
] 
before
 identification of the next fiscal year
ongoing General Fund revenue estimate [
under Subsection (1)(e)
], the Governor's Office of
Management and Budget shall, in cooperation with the Office of the Legislative Fiscal Analyst,
develop an estimate of ongoing General Fund revenue for the next fiscal year and provide [
it
]
the estimate
 to the department 
and the Department of Human Services
 no later than September
1 of each year.
Section 2. Section 
31A-22-649.5
 is amended to read:
31A-22-649.5.
Insurance parity for telemedicine services -- Method of technology
used.
(1) As used in this section:
[
(a) "Telehealth services" means the same as that term is defined in Section
26-60-102
.
]
(a) "Mental health condition" means a mental disorder or a substance-related disorder
that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as
periodically revised.
(b) "Telemedicine services" means the same as that term is defined in Section
26-60-102
.
(2) Notwithstanding the provisions of Section 
31A-22-618.5
, a health benefit plan
offered in the individual market, the small group market, or the large group market [
and
entered into or renewed on or after January 1, 2021,
] shall:
(a) provide coverage for
:
(i)
 telemedicine services that are covered by Medicare; and
[
(b) reimburse, at a commercially reasonable rate, a network provider that provides the
telemedicine services described in Subsection (2)(a).
]
(ii) treatment of a mental health condition through telemedicine services if:
(A) the health benefit plan provides coverage for the treatment of the mental health
condition through in-person services; and
(B) the health benefit plan determines treatment of the mental health condition through
telemedicine services meets the appropriate standard of care; and
(b) reimburse a network provider that provides the telemedicine services described in
Subsection (2)(a) at a negotiated commercially reasonable rate.
(3) 
(a)
 Notwithstanding Section 
31A-45-303
, a health benefit plan providing
[
treatment
] 
coverage
 under Subsection (2)
(a)
 may not impose originating site restrictions,
geographic restrictions, or distance-based restrictions.
(b) A network provider that provides the telemedicine services described in Subsection
(2)(a) may utilize any synchronous audiovisual technology for the telemedicine services that is
compliant with the federal Health Insurance Portability and Accountability Act of 1996.
Section 3. Section 
58-1-401
 is amended to read:
58-1-401.
Grounds for denial of license -- Disciplinary proceedings -- Time
limitations -- Sanctions.
(1) The division shall refuse to issue a license to an applicant and shall refuse to renew
or shall revoke, suspend, restrict, place on probation, or otherwise act upon the license of a
licensee who does not meet the qualifications for licensure under this title.
(2) The division may refuse to issue a license to an applicant and may refuse to renew
or may revoke, suspend, restrict, place on probation, issue a public reprimand to, or otherwise
act upon the license of a licensee for the following reasons:
(a) subject to the provisions of Subsection (7), the applicant or licensee has engaged in
unprofessional conduct, as defined by statute or rule under this title;
(b) the applicant or licensee has engaged in unlawful conduct as defined by statute
under this title;
(c) the applicant or licensee has been determined to be mentally incompetent by a court
of competent jurisdiction; or
(d) 
subject to Subsections 
58-31b-401
(7), 
58-60-108
(2), 
58-61-401
(2), 
58-67-401
(2),
58-68-401
(2), 
58-70a-401
(2), and Section 
58-81-105
,
 the applicant or licensee is unable to
practice the occupation or profession with reasonable skill and safety because of illness,
drunkenness, excessive use of drugs, narcotics, chemicals, or other type of material, or as a
result of a mental or physical condition, when the condition demonstrates a threat or potential
threat to the public health, safety, or welfare.
(3) A licensee whose license to practice an occupation or profession regulated by this
title has been suspended, revoked, placed on probation, or restricted may apply for
reinstatement of the license at reasonable intervals and upon compliance with conditions
imposed upon the licensee by statute, rule, or terms of the license suspension, revocation,
probation, or restriction.
(4) The division may issue cease and desist orders to:
(a) a licensee or applicant who may be disciplined under Subsection (1) or (2);
(b) a person who engages in or represents that the person is engaged in an occupation
or profession regulated under this title; and
(c) a person who otherwise violates this title or a rule adopted under this title.
(5) The division may impose an administrative penalty in accordance with Section
58-1-502
.
(6) (a) The division may not take disciplinary action against a person for
unprofessional or unlawful conduct under this title, unless the division enters into a stipulated
agreement or initiates an adjudicative proceeding regarding the conduct within four years after
the conduct is reported to the division, except under Subsection (6)(b).
(b) (i) The division may not take disciplinary action against a person for unprofessional
or unlawful conduct more than 10 years after the occurrence of the conduct, unless the
proceeding is in response to a civil or criminal judgment or settlement and the proceeding is
initiated within one year following the judgment or settlement.
(ii) Notwithstanding Subsection (6)(b)(i), the division may refuse to issue a license due
to unprofessional or unlawful conduct that occurred more than 10 years before a request or
application for licensure is made.
(7) When the division is determining whether to refuse to issue a license to an
applicant, or to refuse to renew the license of a licensee, based solely on the criminal
conviction of an applicant or licensee, the division shall:
(a) provide individualized consideration to the applicant or licensee;
(b) determine whether the criminal conviction bears a substantial relationship to the
applicant's or licensee's ability to safely or competently practice the occupation or profession;
and
(c) consider the applicant's or licensee's current circumstances, which may include any
of the following:
(i) the age of the applicant or licensee when the applicant or licensee committed the
offense;
(ii) the time that has elapsed since the applicant or licensee committed the offense;
(iii) whether the applicant or licensee has completed the applicant's or licensee's
criminal sentence;
(iv) whether the applicant has completed or is actively participating in rehabilitative
drug or alcohol treatment;
(v) any testimonials or recommendations from other individuals provided by the
applicant or licensee, including a progress report from the applicant's or licensee's probation or
parole officer;
(vi) other evidence of rehabilitation provided by the applicant or licensee;
(vii) the education and training of the applicant or licensee;
(viii) the employment history of the applicant or licensee; and
(ix) other relevant information provided by the applicant or licensee.
Section 4. Section 
58-31b-401
 is amended to read:
58-31b-401.
Grounds for denial of licensure or certification and disciplinary
proceedings.
(1) 
(a) As used in this section, "licensed" or "license" includes certified or certification
under this chapter.
(b) A term or condition applied to the word "nurse" under this section applies to a
medication aide certified.
(2)
 Grounds for refusal to issue a license to an applicant, for refusal to renew the
license of a licensee, to revoke, suspend, restrict, or place on probation the license of a licensee,
to issue a public or private reprimand to a licensee, and to issue cease and desist orders shall be
in accordance with Section 
58-1-401
.
[
(2) If
] 
(3) (a) (i) Subject to Subsection (7), if
 a court of competent jurisdiction
determines a nurse is incapacitated as defined in Section 
75-1-201
 or that the nurse has a
mental illness, as defined in Section 
62A-15-602
, and 
is
 unable to safely engage in the practice
of nursing, the director shall immediately suspend the license of the nurse upon the entry of the
judgment of the court, without further proceedings under Title 63G, Chapter 4, Administrative
Procedures Act, regardless of whether an appeal from the court's ruling is pending.
(ii)
 The director shall promptly notify the nurse in writing of [
the
] 
a
 suspension 
under
Subsection (3)(a)(i)
.
[
(3) (a) If
] 
(b) (i) Subject to Subsection (7), if
 the division and the majority of the
board find reasonable cause to believe a nurse who is not determined judicially to be an
incapacitated person or to have a mental illness, is incapable of practicing nursing with
reasonable skill regarding the safety of patients, because of illness, excessive use of drugs or
alcohol, or as a result of any mental or physical condition, the board shall recommend that the
director file a petition with the division, and cause the petition to be served upon the nurse with
a notice of hearing on the sole issue of the capacity of the nurse to competently, safely engage
in the practice of nursing.
[
(b) The
] 
(ii) Except as provided in Subsection (4), the
 hearing 
described in
Subsection (3)(b)(i)
 shall be conducted under Section 
58-1-109
 and Title 63G, Chapter 4,
Administrative Procedures Act[
, except as provided in Subsection (4)
].
(4) (a) Every nurse who accepts the privilege of being licensed under this chapter gives
consent to:
(i) submitting to an immediate mental or physical examination, at the nurse's expense
and by a division-approved practitioner selected by the nurse when directed in writing by the
division and a majority of the board to do so; and
(ii) the admissibility of the reports of the examining practitioner's testimony or
examination, and waives all objections on the ground the reports constitute a privileged
communication.
(b) The examination may be ordered by the division, with the consent of a majority of
the board, only upon a finding of reasonable cause to believe:
(i) the nurse has a mental illness, is incapacitated, or otherwise unable to practice
nursing with reasonable skill and safety; and
(ii) immediate action by the division and the board is necessary to prevent harm to the
nurse's patients or the general public.
(c) (i) Failure of a nurse to submit to the examination ordered under this section is a
ground for the division's immediate suspension of the nurse's license by written order of the
director.
(ii) The division may enter the order of suspension without further compliance with
Title 63G, Chapter 4, Administrative Procedures Act, unless the division finds the failure to
submit to the examination ordered under this section was due to circumstances beyond the
control of the nurse and was not related directly to the illness or incapacity of the nurse.
(5) (a) A nurse whose license is suspended under Subsection [
(2),
] (3)[
,
] or (4)(c) has
the right to a hearing to appeal the suspension within 10 days after the license is suspended.
(b) The hearing held under this Subsection (5) shall be conducted in accordance with
Sections 
58-1-108
 and 
58-1-109
 for the sole purpose of determining if sufficient basis exists
for the continuance of the order of suspension in order to prevent harm to the nurse's patients or
the general public.
(6) A nurse whose license is revoked, suspended, or in any way restricted under this
section may request the division and the board to consider, at reasonable intervals, evidence
presented by the nurse, under procedures established by division rule, regarding any change in
the nurse's condition, to determine whether:
(a) the nurse is or is not able to safely and competently engage in the practice of
nursing; and
(b) the nurse is qualified to have the nurse's license to practice under this chapter
restored completely or in part.
(7) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
[
(7) Nothing in
]
(8)
 Section 
63G-2-206
 may 
not
 be construed as limiting the authority of the division to
report current significant investigative information to the coordinated licensure information
system for transmission to party states as required of the division by Article VII of the Nurse
Licensure Compact - Revised in Section 
58-31e-102
.
[
(8) For purposes of this section:
]
[
(a) "licensed" or "license" includes "certified" or "certification" under this chapter;
and
]
[
(b) any terms or conditions applied to the word "nurse" in this section also apply to a
medication aide certified.
]
Section 5. Section 
58-60-108
 is amended to read:
58-60-108.
Grounds for action regarding license -- Disciplinary proceedings.
[
The
] 
(1) Subject to Subsection (2), the
 division's grounds for refusing to issue a
license to an applicant, for refusing to renew the license of a licensee, for revoking, suspending,
restricting, or placing on probation the license of a licensee, for issuing a public or private
reprimand to a licensee, and for issuing a cease and desist order are under Section 
58-1-401
.
(2) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
Section 6. Section 
58-61-401
 is amended to read:
58-61-401.
Grounds for action regarding license -- Disciplinary proceedings.
[
The
] 
(1) Subject to Subsection (2), the
 division's grounds for refusing to issue a
license to an applicant, for refusing to renew the license of a licensee, for revoking, suspending,
restricting, or placing on probation the license of a licensee, for issuing a public or private
reprimand to a licensee, and for issuing a cease and desist order are under Section 
58-1-401
.
(2) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
Section 7. Section 
58-67-401
 is amended to read:
58-67-401.
Grounds for denial of license -- Disciplinary proceedings.
[
Grounds
] 
(1) Subject to Subsection (2), grounds
 for division action are set forth in
Sections 
58-1-401
 and 
58-67-503
.
(2) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
Section 8. Section 
58-68-401
 is amended to read:
58-68-401.
Grounds for denial of license -- Disciplinary proceedings.
[
Grounds
] 
(1) Subject to Subsection (2), grounds
 for division action are set forth in
Sections 
58-1-401
 and 
58-68-503
.
(2) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
Section 9. Section 
58-70a-401
 is amended to read:
58-70a-401.
Grounds for denial of license -- Disciplinary proceedings.
[
Grounds
] 
(1) Subject to Subsection (2), grounds
 for the following division actions
regarding a licensee are under Section 
58-1-401
:
[
(1)
] 
(a)
 refusing to issue a license to an applicant;
[
(2)
] 
(b)
 refusing to renew the license of a licensee;
[
(3)
] 
(c)
 revoking, suspending, restricting, or placing on probation the license of a
licensee;
[
(4)
] 
(d)
 issuing a public or private reprimand to a licensee; and
[
(5)
] 
(e)
 issuing a cease and desist order.
(2) The division may not refuse, revoke, suspend, or in any way restrict an applicant or
licensee's license under this chapter solely because the applicant or licensee seeks or
participates in mental health or substance abuse treatment.
Section 10. Section 
58-81-105
 is enacted to read:
 58-81-105.
Grounds for denial of license.
The division may not refuse, revoke, suspend, or in any way restrict the license of a
health care practitioner, as defined in Subsections 
58-81-102
(2)(c), (g), (h), (i), (j), and (l),
under this chapter solely because the health care practitioner seeks or participates in mental
health or substance abuse treatment.
Section 11. 
Appropriation.
The following sums of money are appropriated for the fiscal year beginning July 1,
and ending June 30, 2022. These are additions to amounts previously appropriated for
fiscal year 2022. Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures
Act, the Legislature appropriates the following sums of money from the funds or accounts
indicated for the use and support of the government of the state of Utah.
ITEM 1
To Department of Health -- Medicaid Services
From Federal Funds
$3,780,000
From Federal Funds, One-time
($2,950,000)
From Expendable Receipts
$340,000
From Expendable Receipts, One-time
($260,000)
From Medicaid Expansion Fund
$36,000
From Medicaid Expansion Fund, One-time
($26,000)
Schedule of Programs:
Medicaid Expansion $80,000
Mental Health and Substance Abuse $1,142,600
The Legislature intends that the Department of Health use the appropriations provided
under this item to increase the Medicaid reimbursement rates for mental health plans.
ITEM 2
To Department of Human Services -- Division of Substance Abuse and Mental Health
From General Fund
$1,369,100
From General Fund, One-time
($1,066,500)
Schedule of Programs:
Mental Health Centers $302,600
The Legislature intends that the Department of Human Services use the appropriations
provided under this item to increase the Medicaid reimbursement rates for mental health plans.
Section 12. 
Effective date.
(1) Except as provided in Subsections (2) and (3), this bill takes effect on May 5, 2021.
(2) The amendments to Section 
31A-22-649.5
, if approved by two-thirds of all the
members elected to each house, take effect upon approval by the governor, or the day following
the constitutional time limit of Utah Constitution, Article VII, Section 8, without the governor's
signature, or in the case of a veto, the date of veto override.
(3) The amendments to Section 
26-18-405.5
 take effect on July 1, 2022.
Section 13. 
 Coordinating S.B. 161 with S.B. 41 -- Superseding amendment.
If this S.B. 161 and S.B. 41, Mental Health Access Amendments, both pass and become
law, the Legislature intends that the amendments to Section 
31A-22-649.5
 in this bill supersede
the amendments to Section 
31A-22-649.5
 in S.B. 41 when the Office of Legislative Research
and General Counsel prepare the Utah Code database for publication.