UT
Utah Senate Bill SB0246

Utah 2025 Regular Session

Utah Senate Bill SB0246 Compare Versions

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1-02-28 20:02 1st Sub. (Green) S.B. 246
2-Doug Fiefia proposes the following substitute bill:
1+02-07 14:29 S.B. 246
32 1
43 Medicaid Reimbursement Rate Modifications
54 2025 GENERAL SESSION
65 STATE OF UTAH
76 Chief Sponsor: Todd Weiler
8-House Sponsor: Doug Fiefia
7+House Sponsor:
98 2
109
1110 3
1211 LONG TITLE
1312 4
1413 General Description:
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1615 This bill addresses Medicaid reimbursement rates.
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1817 Highlighted Provisions:
1918 7
2019 This bill:
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22-▸ extends by a number of fiscal years a budgeting mechanism under which Medicaid
21+▸ directs that the base budget include an annual appropriation to the Department of Health
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24-reimbursement rates for applied behavior analysis may increase.
23+and Human Services to increase the fiscal year fee-for-service rates for services applying
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25+applied behavior analysis; and
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27+▸ makes conforming changes.
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2629 Money Appropriated in this Bill:
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28-None
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30-Other Special Clauses:
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3231 None
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33+Other Special Clauses:
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35+None
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3437 Utah Code Sections Affected:
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38+17
3639 AMENDS:
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3841 26B-3-203, as last amended by Laws of Utah 2024, Chapters 264, 284
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4043
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4245 Be it enacted by the Legislature of the state of Utah:
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4447 Section 1. Section 26B-3-203 is amended to read:
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4649 26B-3-203 . Base budget appropriations for Medicaid accountable care
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4851 organizations, behavioral health plans, and ABA services -- Forecast of behavioral health
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5053 services cost, behavioral health plans, and ABA services -- Forecast of behavioral health
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5255 services cost.
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5457 (1) As used in this section:
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5659 (a) "ABA service" means a service applying applied behavior analysis, as that term is
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5861 defined in Section 31A-22-642.
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6063 (b) "ABA service reimbursement rate" means the Medicaid reimbursement rate
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6265 developed by the division, in accordance with Part 1, Health Care Assistance, and
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66+ S.B. 246 S.B. 246 02-07 14:29
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6468 paid to a provider for providing an ABA service.
65-1st Sub. S.B. 246 1st Sub. (Green) S.B. 246 02-28 20:02
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6770 (c) "ACO" means a Medicaid accountable care organization that contracts with the
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6972 state's Medicaid program for:
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7174 (i) physical health services; or
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7376 (ii) integrated physical and behavioral health services.
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7578 (d) "Base budget" means the same as that term is defined in legislative rule.
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7780 (e) "Behavioral health plan" means a managed care or fee-for-service delivery system
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7982 that contracts with or is operated by the department to provide behavioral health
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8184 services to Medicaid eligible individuals.
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8386 (f) "Behavioral health services" means mental health or substance use treatment or
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8588 services.
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8790 (g) "General Fund growth factor" means the amount determined by dividing the next
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8992 fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
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9194 appropriations from the General Fund.
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9396 (h) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal year
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9598 ongoing General Fund revenue estimate identified by the Executive Appropriations
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97100 Committee, in accordance with legislative rule, for use by the Office of the
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99102 Legislative Fiscal Analyst in preparing budget recommendations.
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101104 (i) "Member" means an enrollee.
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103106 (j) "PMPM" means per-member-per-month funding.
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105108 (2) If the General Fund growth factor is less than 100%, the next fiscal year base budget
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107-shall, subject to Subsection (5), include an appropriation to the department in an amount
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109-necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
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111-plans equals the current fiscal year PMPM for the ACOs and behavioral health plans
110+shall, subject to Subsection [(5)] (6), include an appropriation to the department in an
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113-multiplied by 100%.
112+amount necessary to ensure that the next fiscal year PMPM for ACOs and behavioral
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114+health plans equals the current fiscal year PMPM for the ACOs and behavioral health
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116+plans multiplied by 100%.
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115118 (3) If the General Fund growth factor is greater than or equal to 100%, but less than 102%,
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117-the next fiscal year base budget shall, subject to Subsection (5), include an appropriation
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119-to the department in an amount necessary to ensure that the next fiscal year PMPM for
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121-ACOs and behavioral health plans equals the current fiscal year PMPM for the ACOs
120+the next fiscal year base budget shall, subject to Subsection [(5)] (6), include an
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123-and behavioral health plans multiplied by the General Fund growth factor.
122+appropriation to the department in an amount necessary to ensure that the next fiscal
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125-(4) If the General Fund growth factor is greater than or equal to 102% for a fiscal year, the
124+year PMPM for ACOs and behavioral health plans equals the current fiscal year PMPM
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127-next fiscal year base budget shall, subject to Subsection (5):
126+for the ACOs and behavioral health plans multiplied by the General Fund growth factor.
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129-(a) [in fiscal years 2025 and ] for the 2026 and 2027 base budget:
128+(4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal year
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131-(i) include an appropriation to the department in an amount that would, prior to the
130+base budget shall, subject to [Subsection (5):] Subsection (6), include an appropriation to
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132+the department in an amount necessary to ensure that the next fiscal year PMPM for
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134+ACOs and behavioral health plans is greater than or equal to the current fiscal year
135+- 2 - 02-07 14:29 S.B. 246
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137+PMPM for the ACOs and behavioral health plans multiplied by 102% and less than or
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139+equal to the current fiscal year PMPM for the ACOs and behavioral health plans
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141+multiplied by the General Fund growth factor.
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143+[(a) in fiscal years 2025 and 2026:]
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145+[(i) include an appropriation to the department in an amount that would, prior to the
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133147 application of Subsection (4)(a)(ii), allow the department to ensure that the next
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136149 fiscal year PMPMs for ACOs and behavioral health plans is greater than or equal
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138151 to the current fiscal year PMPMs for the ACOs and behavioral health plans
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140-multiplied by 102%; and
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142-(ii) [subject to Subsection (4)(a)(iii), ]allocate the amount appropriated under
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153+multiplied by 102%;]
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155+[(ii) subject to Subsection (4)(a)(iii), allocate the amount appropriated under
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144157 Subsection (4)(a)(i) to provide substantially the same year-over-year percentage
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146-point increase to:
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148-(A) the PMPMs for ACOs and behavioral health plans; and
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150-(B) each ABA service reimbursement rate; and
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152-(iii) [for the initial appropriation under Subsection (4)(a)(i), prior to providing the
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159+point increase to:]
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161+[(A) the PMPMs for ACOs and behavioral health plans; and]
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163+[(B) each ABA service reimbursement rate; and]
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165+[(iii) for the initial appropriation under Subsection (4)(a)(i), prior to providing the
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154167 percentage point increases under Subsection (4)(a)(ii), allocate from the total
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156169 amount appropriated under Subsection (4)(a)(i) an amount necessary to increase
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158171 and substantially equalize each of the ABA service reimbursement rates with a
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160173 corresponding reimbursement rate paid for providing the same or substantially
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162175 similar service under an ACO or a behavioral health plan; and]
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164-(b) beginning in fiscal year 2027 for the 2028 base budget, include an appropriation to
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166-the department in an amount necessary to ensure that the next fiscal year PMPMs for
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168-ACOs and behavioral health plans is greater than or equal to the current fiscal year
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170-PMPMs for the ACOs and the behavioral health plans multiplied by 102%, and less
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172-than or equal to the current fiscal year PMPMs for the ACOs and the behavioral
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174-health plans multiplied by the General Fund growth factor.
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176-(5) The appropriations provided to the department for behavioral health plans under this
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178-section shall be reduced by the amount contributed by counties in the current fiscal year
177+[(b) beginning in fiscal year 2027, include an appropriation to the department in an
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180-for behavioral health plans in accordance with Subsections 17-43-201(5)(k) and
179+amount necessary to ensure that the next fiscal year PMPMs for ACOs and
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181+behavioral health plans is greater than or equal to the current fiscal year PMPMs for
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183+the ACOs and the behavioral health plans multiplied by 102%, and less than or equal
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185+to the current fiscal year PMPMs for the ACOs and the behavioral health plans
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187+multiplied by the General Fund growth factor.]
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189+(5) Beginning with the base budget for fiscal year 2026, each fiscal year base budget shall
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191+include an appropriation to the department that:
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193+(a) is proportional to the appropriation under Subsections (2) through (4); and
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195+(b) is used to increase the fiscal year fee-for-service rates for ABA services.
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197+[(5)] (6) The appropriations provided to the department for behavioral health plans under
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199+this section shall be reduced by the amount contributed by counties in the current fiscal
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201+year for behavioral health plans in accordance with Subsections 17-43-201(5)(k) and
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182203 17-43-301(6)(a)(x).
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184-(6) In order for the department to estimate the impact of Subsections (2) through (4) before
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186-identification of the next fiscal year ongoing General Fund revenue estimate, the
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188-Governor's Office of Planning and Budget shall, in cooperation with the Office of the
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190-Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the
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192-next fiscal year and provide the estimate to the department no later than November 1 of
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194-each year.
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196-(7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
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204+- 3 - S.B. 246 02-07 14:29
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206+[(6)] (7) In order for the department to estimate the impact of Subsections (2) through [(4) ]
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208+(5) before identification of the next fiscal year ongoing General Fund revenue estimate,
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210+the Governor's Office of Planning and Budget shall, in cooperation with the Office of
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212+the Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for
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214+the next fiscal year and provide the estimate to the department no later than November 1
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216+of each year.
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218+[(7)] (8) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
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198220 behavioral health services in any state Medicaid funding or savings forecast that is
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200222 completed in coordination with the department and the Governor's Office of Planning
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202224 and Budget.
203-- 3 - 1st Sub. (Green) S.B. 246 02-28 20:02
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205226 Section 2. Effective Date.
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207228 This bill takes effect on May 7, 2025.
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