26B-3-138. 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 26B-3-207. |
Terms Used In Utah Code 26B-3-138
- Contract: A legal written agreement that becomes binding when signed.
- Executive director: means the executive director of the department appointed under Section 26B-1-203. See Utah Code 26B-1-102
- Medicaid program: means the state program for medical assistance for persons who are eligible under the state plan adopted pursuant to Title XIX of the federal Social Security Act. See Utah Code 26B-3-101
- member: means an individual whom the department has determined to be eligible for assistance under the Medicaid program. See Utah Code 26B-3-101
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- Statute: A law passed by a legislature.
| (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 26B-3-223(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:
| (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. |
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|
| (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:
| (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. |
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Renumbered and Amended by Chapter 306, 2023 General Session
