Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 413 Second Substitute (2022GS)

Sponsor

Rep. Dunnigan, J.

Final action

Governor Signed 3/24/2022

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• amends provisions relating to the targeted adult Medicaid program;
• requires the department to convene a working group to discuss the delivery of behavioral health services in the Medicaid program; and
• authorizes certain adjustments in the delivery of behavioral health services for individuals who are in the targeted adult Medicaid program if the department determines that certain requirements are met.

Every vote on this bill

Bill text

MEDICAID AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: James A. Dunnigan
Senate Sponsor: 
Michael S. Kennedy
LONG TITLE
General Description:
This bill modifies provisions related to the Medicaid program.
Highlighted Provisions:
This bill:
▸ amends provisions relating to the targeted adult Medicaid program;
▸ requires the department to convene a working group to discuss the delivery of
behavioral health services in the Medicaid program; and
▸ authorizes certain adjustments in the delivery of behavioral health services for
individuals who are in the targeted adult Medicaid program if the department
determines that certain requirements are met.
Money Appropriated in this Bill:
This bill appropriates in fiscal year 2023:
▸ to Department of Health and Human Services -- Integrated Health Care Services --
Medicaid Behavioral Health Services, as an ongoing appropriation:
• from the General Fund, $436,000.
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26-18-411
, as last amended by Laws of Utah 2020, Chapter 225
ENACTS:
26-18-427
, Utah Code Annotated 1953
26-18-428
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-411
 is amended to read:
26-18-411.
Health coverage improvement program -- Eligibility -- Annual report
-- Expansion of eligibility for adults with dependent children.
(1) [
For purposes of
] 
As used in
 this section:
(a) "Adult in the expansion population" means an individual who:
(i) is described in 42 U.S.C. Sec. 1396a(a)(10)(A)(i)(VIII); and
(ii) is not otherwise eligible for Medicaid as a mandatory categorically needy
individual.
(b) "Enhancement waiver program" means the Primary Care Network enhancement
waiver program described in Section 
26-18-416
.
(c) "Federal poverty level" means the poverty guidelines established by the Secretary of
the United States Department of Health and Human Services under 42 U.S.C. Sec. 9909(2).
(d) "Health coverage improvement program" means the health coverage improvement
program described in Subsections (3) through (10).
(e) "Homeless":
(i) means an individual who is chronically homeless, as determined by the department;
and
(ii) includes someone who was chronically homeless and is currently living in
supported housing for the chronically homeless.
(f) "Income eligibility ceiling" means the percent of federal poverty level:
(i) established by the state in an appropriations act adopted pursuant to Title 63J,
Chapter 1, Budgetary Procedures Act; and
(ii) under which an individual may qualify for Medicaid coverage in accordance with
this section.
(g) "Targeted adult Medicaid program" means the program implemented by the
department under Subsections (5) through (7).
(2) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
allow temporary residential treatment for substance abuse, for the traditional Medicaid
population, in a short term, non-institutional, 24-hour facility, without a bed capacity limit that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan, as approved by CMS and as long as the county makes the
required match under Section 
17-43-201
.
(3) Beginning July 1, 2016, the department shall amend the state Medicaid plan to
increase the income eligibility ceiling to a percentage of the federal poverty level designated by
the department, based on appropriations for the program, for an individual with a dependent
child.
(4) Before July 1, 2016, the division shall submit to CMS a request for waivers, or an
amendment of existing waivers, from federal statutory and regulatory law necessary for the
state to implement the health coverage improvement program in the Medicaid program in
accordance with this section.
(5) (a) An adult in the expansion population is eligible for Medicaid if the adult meets
the income eligibility and other criteria established under Subsection (6).
(b) An adult who qualifies under Subsection (6) shall receive Medicaid coverage:
(i) through the traditional fee for service Medicaid model in counties without Medicaid
accountable care organizations or the state's Medicaid accountable care organization delivery
system, where implemented 
and subject to Section 
26-18-428
;
(ii) except as provided in Subsection (5)(b)(iii), for behavioral health, through the
counties in accordance with Sections 
17-43-201
 and 
17-43-301
;
(iii) that
, subject to Section 
26-18-428
,
 integrates behavioral health services and
physical health services with Medicaid accountable care organizations in select geographic
areas of the state that choose an integrated model; and
(iv) that permits temporary residential treatment for substance abuse in a short term,
non-institutional, 24-hour facility, without a bed capacity limit, as approved by CMS, that
provides rehabilitation services that are medically necessary and in accordance with an
individualized treatment plan.
[
(c) Medicaid accountable care organizations and counties that elect to integrate care
under Subsection (5)(b)(iii) shall collaborate on enrollment, engagement of patients, and
coordination of services.
]
(6) (a) An individual is eligible for the health coverage improvement program under
Subsection (5) if:
(i) at the time of enrollment, the individual's annual income is below the income
eligibility ceiling established by the state under Subsection (1)(f); and
(ii) the individual meets the eligibility criteria established by the department under
Subsection (6)(b).
(b) Based on available funding and approval from CMS, the department shall select the
criteria for an individual to qualify for the Medicaid program under Subsection (6)(a)(ii), based
on the following priority:
(i) a chronically homeless individual;
(ii) if funding is available, an individual:
(A) involved in the justice system through probation, parole, or court ordered
treatment; and
(B) in need of substance abuse treatment or mental health treatment, as determined by
the department; or
(iii) if funding is available, an individual in need of substance abuse treatment or
mental health treatment, as determined by the department.
(c) An individual who qualifies for Medicaid coverage under Subsections (6)(a) and (b)
may remain on the Medicaid program for a 12-month certification period as defined by the
department. Eligibility changes made by the department under Subsection (1)(f) or (6)(b) shall
not apply to an individual during the 12-month certification period.
(7) The state may request a modification of the income eligibility ceiling and other
eligibility criteria under Subsection (6) each fiscal year based on projected enrollment, costs to
the state, and the state budget.
(8) Before September 30 of each year, the department shall report to the Health and
Human Services Interim Committee and to the Executive Appropriations Committee:
(a) the number of individuals who enrolled in Medicaid under Subsection (6);
(b) the state cost of providing Medicaid to individuals enrolled under Subsection (6);
and
(c) recommendations for adjusting the income eligibility ceiling under Subsection (7),
and other eligibility criteria under Subsection (6), for the upcoming fiscal year.
(9) The current Medicaid program and the health coverage improvement program,
when implemented, shall coordinate with a state prison or county jail to expedite Medicaid
enrollment for an individual who is released from custody and was eligible for or enrolled in
Medicaid before incarceration.
(10) Notwithstanding Sections 
17-43-201
 and 
17-43-301
, a county does not have to
provide matching funds to the state for the cost of providing Medicaid services to newly
enrolled individuals who qualify for Medicaid coverage under the health coverage
improvement program under Subsection (6).
(11) If the enhancement waiver program is implemented, the department:
(a) may not accept any new enrollees into the health coverage improvement program
after the day on which the enhancement waiver program is implemented;
(b) shall transition all individuals who are enrolled in the health coverage improvement
program into the enhancement waiver program;
(c) shall suspend the health coverage improvement program within one year after the
day on which the enhancement waiver program is implemented;
(d) shall, within one year after the day on which the enhancement waiver program is
implemented, use all appropriations for the health coverage improvement program to
implement the enhancement waiver program; and
(e) shall work with CMS to maintain any waiver for the health coverage improvement
program while the health coverage improvement program is suspended under Subsection
(11)(c).
(12) If, after the enhancement waiver program takes effect, the enhancement waiver
program is repealed or suspended by either the state or federal government, the department
shall reinstate the health coverage improvement program and continue to accept new enrollees
into the health coverage improvement program in accordance with the provisions of this
section.
Section 2. Section 
26-18-427
 is enacted to read:
 26-18-427.
Behavioral health delivery working group.
(1) As used in this section, "targeted adult Medicaid program" means the same as that
term is defined in Section 
26-18-411
.
(2) On or before May 31, 2022, the department shall convene a working group to
collaborate with the department on:
(a) establishing specific and measurable metrics regarding:
(i) compliance of managed care organizations in the state with federal Medicaid
managed care requirements;
(ii) timeliness and accuracy of authorization and claims processing in accordance with
Medicaid policy and contract requirements;
(iii) reimbursement by managed care organizations in the state to providers to maintain
adequacy of access to care;
(iv) availability of care management services to meet the needs of Medicaid-eligible
individuals enrolled in the plans of managed care organizations in the state; and
(v) timeliness of resolution for disputes between a managed care organization and the
managed care organization's providers and enrollees;
(b) improving the delivery of behavioral health services in the Medicaid program;
(c) proposals to implement the delivery system adjustments authorized under
Subsection 
26-18-428
(3); and
(d) issues that are identified by managed care organizations, behavioral health service
providers, and the department.
(3) The working group convened under Subsection (2) shall:
(a) meet quarterly; and
(b) consist of at least the following individuals:
(i) the executive director or the executive director's designee;
(ii) for each Medicaid accountable care organization with which the department
contracts, an individual selected by the accountable care organization;
(iii) five individuals selected by the department to represent various types of behavioral
health services providers, including, at a minimum, individuals who represent providers who
provide the following types of services:
(A) acute inpatient behavioral health treatment;
(B) residential treatment;
(C) intensive outpatient or partial hospitalization treatment; and
(D) general outpatient treatment;
(iv) a representative of an association that represents behavioral health treatment
providers in the state, designated by the Utah Behavioral Healthcare Council convened by the
Utah Association of Counties;
(v) a representative of an organization representing behavioral health organizations;
(vi) the chair of the Utah Substance Use and Mental Health Advisory Council created
in Section 
63M-7-301
;
(vii) a representative of an association that represents local authorities who provide
public behavioral health care, designated by the department;
(viii) one member of the Senate, appointed by the president of the Senate; and
(ix) one member of the House of Representatives, appointed by the speaker of the
House of Representatives.
(4) The working group convened under this section shall recommend to the
department:
(a) specific and measurable metrics under Subsection (2)(a);
(b) how physical and behavioral health services may be integrated for the targeted adult
Medicaid program, including ways the department may address issues regarding:
(i) filing of claims;
(ii) authorization and reauthorization for treatment services;
(iii) reimbursement rates; and
(iv) other issues identified by the department, behavioral health services providers, or
Medicaid managed care organizations;
(c) ways to improve delivery of behavioral health services to enrollees, including
changes to statute or administrative rule; and
(d) wraparound service coverage for enrollees who need specific, nonclinical services
to ensure a path to success.
Section 3. Section 
26-18-428
 is enacted to read:
 26-18-428.
Delivery system adjustments for the targeted adult Medicaid program.
(1) As used in this section, "targeted adult Medicaid program" means the same as that
term is defined in Section 
26-18-411
.
(2) The department may implement the delivery system adjustments authorized under
Subsection (3) only on the later of:
(a) July 1, 2023; and
(b) the department determining that the Medicaid program, including providers and
managed care organizations, are satisfying the metrics established in collaboration with the
working group convened under Subsection 
26-18-427
(2).
(3) The department may, for individuals who are enrolled in the targeted adult
Medicaid program:
(a) integrate the delivery of behavioral and physical health in certain counties; and
(b) deliver behavioral health services through an accountable care organization where
implemented.
(4) Before implementing the delivery system adjustments described in Subsection (3)
in a county, the department shall, at a minimum, seek input from:
(a) individuals who qualify for the targeted adult Medicaid program who reside in the
county;
(b) the county's executive officer, legislative body, and other county officials who are
involved in the delivery of behavioral health services;
(c) the local mental health authority and substance use authority that serves the county;
(d) Medicaid managed care organizations operating in the state, including Medicaid
accountable care organizations;
(e) providers of physical or behavioral health services in the county who provide
services to enrollees in the targeted adult Medicaid program in the county; and
(f) other individuals that the department deems necessary.
(5) If the department provides Medicaid coverage through a managed care delivery
system under this section, the department shall include language in the department's managed
care contracts that require the managed care plan to:
(a) be in compliance with federal Medicaid managed care requirements;
(b) timely and accurately process authorizations and claims in accordance with
Medicaid policy and contract requirements;
(c) adequately reimburse providers to maintain adequacy of access to care;
(d) provide care management services sufficient to meet the needs of Medicaid eligible
individuals enrolled in the managed care plan's plan; and
(e) timely resolve any disputes between a provider or enrollee with the managed care
plan.
(6) The department may take corrective action if the managed care organization fails to
comply with the terms of the managed care organization's contract.
Section 4. 
Appropriation.
The following sums of money are appropriated for the fiscal year beginning July 1,
2022, and ending June 30, 2023. These are additions to amounts previously appropriated for
fiscal year 2023. 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 the Department of Health and Human Services - Integrated Health Care Services
From General Fund
$436,000
Schedule of Programs:
Medicaid Behavioral Health Services $436,000
The Legislature intends that appropriations provided under this section be used by the
Division of Integrated Healthcare within the Department of Health and Human Services to pass
through to local substance abuse and mental health authorities to pay for the local substance
abuse and mental health authorities' increased match requirement associated with the request
for appropriation in the 2022 General Session entitled Alignment of Behavioral Health Service
Codes for Medicaid Reimbursement.