26B-3-227.  Recreational therapy — Reimbursement.

(1)  As used in this section:

Terms Used In Utah Code 26B-3-227

  • 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
  • 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)  “Assisted living facility” means the same as that term is defined in Section 26-21-2.

(b)  “Behavioral health program” means a behavioral health program described in Title 62A, Chapter 15, Substance Abuse and Mental Health Act.

(c)  “General acute hospital” means the same as that term is defined in Section 26-21-2.

(d)  “Intermediate care facility” means the same as that term is defined in Section 58-15-101.

(e)  “Mental health therapist” means the same as that term is defined in Section 58-60-102.

(f)  “Qualified enrollee” means an individual who:

(i)  is enrolled in the Medicaid program; and

(ii)  has been referred for recreational therapy services by a mental health therapist.

(g)  “Recreational therapy services” means the same as that term is defined in Section 58-40-102.

(h)  “Skilled nursing facility” means the same as that term is defined in Section 58-15-101.

(i)  “Youth residential treatment facility” means a facility that provides a 24-hour group living environment for four or more individuals who are under 18 years old and who are unrelated to the owner or provider of the facility.

(2)  Before January 1, 2024, the department shall apply for a Medicaid waiver or a state plan with CMS to allow for reimbursement for recreational therapy services provided:

(a)  to a qualified enrollee;

(b)  by an individual authorized to engage in the practice of recreational therapy under Title 58, Chapter 40, Recreational Therapy Practice Act; and

(c)  at a:

(i)  general acute hospital;

(ii)  youth residential treatment facility;

(iii)  behavioral health program;

(iv)  intermediate care facility;

(v)  assisted living facility;

(vi)  skilled nursing facility;

(vii)  psychiatric hospital; or

(viii)  mental health agency.

(3)  If the waiver or state plan amendment described in Subsection (2) is approved, the Medicaid program shall provide coverage to a qualified enrollee for recreational therapy services.

Enacted by Chapter 288, 2023 General Session

Technical renumber of section for proper placement in Title and Chapter.

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