26B-3-219. Reimbursement for crisis management services provided in a behavioral health receiving center — Integration of payment for physical health services.
| (1) |
As used in this section:
Terms Used In Utah Code 26B-3-219- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- CMS: means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. See Utah Code 26B-3-101
- Division: means the Division of Integrated Healthcare within the department, established under Section 26B-3-102. See Utah Code 26B-3-101
- 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
- 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
| (a) |
“Accountable care organization” means the same as that term is defined in Section 26B-3-204. |
| (b) |
“Behavioral health receiving center” means the same as that term is defined in Section 26B-4-114. |
| (c) |
“Crisis management services” means behavioral health services provided to an individual who is experiencing a mental health crisis. |
| (d) |
“Managed care organization” means the same as that term is defined in 42 C.F.R. § 438.2. |
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| (2) |
Before July 1, 2020, the division shall apply for a Medicaid waiver or state plan amendment with CMS to offer a program that provides reimbursement through a bundled daily rate for crisis management services that are delivered to an individual during the individual’s stay at a behavioral health receiving center. |
| (3) |
If the waiver or state plan amendment described in Subsection (2) is approved, the department shall:
| (a) |
implement the program described in Subsection (2); and |
| (b) |
require a managed care organization that contracts with the state’s Medicaid program for behavioral health services or integrated health services to provide coverage for crisis management services that are delivered to an individual during the individual’s stay at a behavioral health receiving center. |
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| (4) |
| (a) |
The department may elect to integrate payment for physical health services provided in a behavioral health receiving center. |
| (b) |
In determining whether to integrate payment under Subsection (4)(a), the department shall consult with accountable care organizations and counties in the state. |
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Renumbered and Amended by Chapter 306, 2023 General Session
