SB 160

 Enrolled Copy  S.B. 160
1Medicaid Reimbursement Rate Amendments
                                       2026 GENERAL SESSION
                                            STATE OF UTAH
                                     Chief Sponsor: Todd Weiler
                                   House Sponsor: Stephanie Gricius
2
3  LONG TITLE
4  General Description:
5      This bill addresses Medicaid treatment rates.
6  Highlighted Provisions:
7      This bill:
8      ▸ makes permanent the budgeting mechanism under which Medicaid reimbursement rates
9  for applied behavior analysis may increase.
10  Money Appropriated in this Bill:
11      None
12  Other Special Clauses:
13      None
14  Utah Code Sections Affected:
15  AMENDS:
16      26B-3-203, as last amended by Laws of Utah 2025, First Special Session, Chapter 16
17
18  Be it enacted by the Legislature of the state of Utah:
19Section 1. Section 26B-3-203 is amended to read:
2026B-3-203 . Base budget appropriations for Medicaid accountable care
21  organizations and behavioral health plans -- Forecast of behavioral health services cost,
22  behavioral health plans, and ABA services -- Forecast of behavioral health services cost.
23  (1) As used in this section:
24      (a) "ABA service" means a service applying applied behavior analysis, as that term is
25defined in Section 31A-22-642.
26      (b) "ABA service reimbursement rate" means the Medicaid reimbursement rate
27developed by the division, in accordance with Part 1, Health Care Assistance, and
28paid to a provider for providing an ABA service.
 S.B. 160  Enrolled Copy
29(c) "ACO" means a Medicaid accountable care organization that contracts with the
30state's Medicaid program for:
31(i) physical health services; or
32(ii) integrated physical and behavioral health services.
33(d) "Base budget" means the same as that term is defined in legislative rule.
34(e) "Behavioral health plan" means a managed care or fee-for-service delivery system
35that contracts with or is operated by the department to provide behavioral health
36services to Medicaid eligible individuals.
37(f) "Behavioral health services" means mental health or substance use treatment or
38services.
39(g) "General Fund growth factor" means the amount determined by dividing the next
40fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing
41appropriations from the General Fund.
42(h) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal year
43ongoing General Fund revenue estimate identified by the Executive Appropriations
44Committee, in accordance with legislative rule, for use by the Office of the
45Legislative Fiscal Analyst in preparing budget recommendations.
46(i) "Member" means an enrollee.
47(j) "PMPM" means per-member-per-month funding.
48   (2) If the General Fund growth factor is less than 100%, the next fiscal year base budget
49shall, subject to Subsection (5), include an appropriation to the department in an amount
50necessary to ensure that the next fiscal year PMPM for ACOs and behavioral health
51plans equals the current fiscal year PMPM for the ACOs and behavioral health plans
52multiplied by 100%.
53   (3) If the General Fund growth factor is greater than or equal to 100%, but less than 102%,
54the next fiscal year base budget shall, subject to Subsection (5), include an appropriation
55to the department in an amount necessary to ensure that the next fiscal year PMPM for
56ACOs and behavioral health plans equals the current fiscal year PMPM for the ACOs
57and behavioral health plans multiplied by the General Fund growth factor.
58   (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal year
59base budget shall, subject to Subsection (5):
60[(a) in fiscal years 2025 and 2026:]
61[(i)] (a) include an appropriation to the department in an amount that would, prior to the
62application of Subsection [(4)(a)(ii)] (4)(b), allow the department to ensure that the
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 Enrolled Copy  S.B. 160
63next fiscal year PMPMs for ACOs and behavioral health plans is greater than or
64equal to the current fiscal year PMPMs for the ACOs and behavioral health plans
65multiplied by 102%;
66      [(ii)] (b) subject to Subsection [(4)(a)(iii)] (4)(c), allocate the amount appropriated under
67Subsection [(4)(a)(i)] (4)(a) to provide substantially the same year-over-year
68percentage point increase to:
69[(A)] (i) the PMPMs for ACOs and behavioral health plans; and
70[(B)] (ii) each ABA service reimbursement rate; and
71      [(iii)] (c) for the initial appropriation under Subsection [(4)(a)(i)] (4)(a), prior to providing
72the percentage point increases under Subsection [(4)(a)(ii)] (4)(b), allocate from the
73total amount appropriated under Subsection [(4)(a)(i)] (4)(a) an amount necessary to
74increase and substantially equalize each of the ABA service reimbursement rates with
75a corresponding reimbursement rate paid for providing the same or substantially
76similar service under an ACO or a behavioral health plan[; and] .
77      [(b) beginning in fiscal year 2027, include an appropriation to the department in an
78amount necessary to ensure that the next fiscal year PMPMs for ACOs and
79behavioral health plans is greater than or equal to the current fiscal year PMPMs for
80the ACOs and the behavioral health plans multiplied by 102%, and less than or equal
81to the current fiscal year PMPMs for the ACOs and the behavioral health plans
82multiplied by the General Fund growth factor.]
83  (5) The appropriations provided to the department for behavioral health plans under this
84      section shall be reduced by the amount contributed by counties in the current fiscal year
85      for behavioral health plans in accordance with Subsections 17-77-201(5)(k) and
86      17-77-301(5)(a)(x).
87  (6) In order for the department to estimate the impact of Subsections (2) through (4) before
88      identification of the next fiscal year ongoing General Fund revenue estimate, the
89      Governor's Office of Planning and Budget shall, in cooperation with the Office of the
90      Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the
91      next fiscal year and provide the estimate to the department no later than November 1 of
92      each year.
93  (7) The Office of the Legislative Fiscal Analyst shall include an estimate of the cost of
94      behavioral health services in any state Medicaid funding or savings forecast that is
95      completed in coordination with the department and the Governor's Office of Planning
96      and Budget.
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 S.B. 160  Enrolled Copy
97Section 2. Effective Date.
98   This bill takes effect on May 6, 2026.
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