SB 288

Enrolled Copy  S.B. 288
1Medicaid Provider Amendments
                                      2026 GENERAL SESSION
                                           STATE OF UTAH
                                  Chief Sponsor: Keven J. Stratton
                                     House Sponsor: Steve Eliason
2
3  LONG TITLE
4  General Description:
5      This bill addresses provisions related to Medicaid providers.
6  Highlighted Provisions:
7      This bill:
8      ▸ requires the Department of Health and Human Services (department) to:
9●    establish quality measures for evaluating certain Medicaid providers' performance;
10●    evaluate certain Medicaid providers on performance as measured by the quality
11  measures; and
12●    annually report to the Social Services Appropriations Subcommittee on the
13  performance based on the quality measures of the Medicaid providers determined by
14  the Legislature;
15      ▸ requires the department to implement a closed loop referral system for referrals for the
16  delivery of health-related social needs care to Medicaid-eligible individuals;
17      ▸ requires the Division of Services for People with Disabilities (division) to notify a
18  provider of amendments to the provider's contract with the division;
19      ▸ defines terms; and
20      ▸ makes technical and conforming changes.
21  Money Appropriated in this Bill:
22      This bill appropriates $42,778,300 in operating and capital budgets for fiscal year 2027,
23  including:
24      ▸   $16,888,300 from General Fund; and
25      ▸   $25,890,000 from various sources as detailed in this bill.
26  Other Special Clauses:
27      None
S.B. 288  Enrolled Copy
28   Utah Code Sections Affected:
29   AMENDS:
3026B-6-403, as renumbered and amended by Laws of Utah 2023, Chapter 308
31   ENACTS:
3226B-3-143, Utah Code Annotated 1953
3326B-3-144, Utah Code Annotated 1953
34
35   Be it enacted by the Legislature of the state of Utah:
36Section 1. Section 26B-3-143 is enacted to read:
3726B-3-143 . Medicaid provider quality measures -- Reporting -- Eligibility for
38   incentive payments.
39   (1) As used in this section:
40(a) "Incentive payment" means a one-time fee-for-services payment to a participating
41Medicaid provider, including a managed care entity or a Medicaid provider that is
42paid under a fee-for-service arrangement, based on the Medicaid provider's
43performance as evaluated by the department as described in this section.
44(b) "Managed care entity" means a person that contracts with the Medicaid program to
45manage the provision of health care services in a managed care delivery system on a
46capitated basis.
47(c) "Medicaid provider" means any person, individual, corporation, institution, or
48organization that:
49(i) is currently enrolled in the Medicaid program;
50(ii) provides Medicaid-covered services under the Medicaid program;
51(iii) has entered into a provider agreement with the Medicaid program; and
52(iv) is reimbursed:
53(A) through a managed care entity; or
54(B) fee-for-service.
55(d) "Participating Medicaid provider" means a Medicaid provider:
56(i) that is in a group of Medicaid providers selected by the Legislature and that the
57Legislature directs the department to evaluate in a fiscal year as described in
58Subsection (5)(a); and
59(ii) that submits verifying documentation of the Medicaid provider's completion or
60progress toward quality measures in accordance with rules made by the
61department under this section.
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62      (e) "Quality measures" means the metrics the department establishes to evaluate a
63Medicaid provider's performance as described in Subsection (2).
64  (2)(a) The department shall make rules in accordance with Title 63G, Chapter 3, Utah
65      Administrative Rulemaking Act, to establish quality measures.
66      (b) Quality measures may include:
67(i) improved health outcomes and care experience for enrollees;
68(ii) care coordination, data sharing, and value-based delivery;
69(iii) workforce stability and evidence-based clinical practices; and
70(iv) any other metrics or performance areas the department deems appropriate.
71      (c) The department shall establish separate quality measures for each Medicaid provider
72type selected for participation in accordance with the process described in
73Subsections (4) and (5).
74  (3)(a) The department shall make rules in accordance with Title 63G, Chapter 3, Utah
75      Administrative Rulemaking Act, to establish:
76(i) a process for a participating Medicaid provider to submit documentation verifying
77the participating Medicaid provider's completion or progress toward the quality
78measures established for the Medicaid provider's provider type;
79(ii) a methodology for evaluating a participating Medicaid provider's progress toward
80quality measures; and
81(iii) exclusions for a Medicaid provider's participation based on adverse findings or
82disciplinary actions by a certifying, licensing, or accrediting entity.
83      (b) The department shall report to the Rules Review and General Oversight Committee
84on rules the department makes in accordance with this Subsection (3).
85  (4)(a) The department shall annually, before October 31, submit a report to the Social
86      Services Appropriations Subcommittee of the department's evaluation of:
87(i) Medicaid provider types to assist the Legislature in selecting and prioritizing
88Medicaid providers eligible for incentive payments under Subsection (6) in the
89following fiscal year; and
90(ii) participating Medicaid providers' completion or progress toward quality measures
91as described in Subsection (3)(a)(ii), if any.
92      (b) The report described in Subsection (4)(a)(i) shall include:
93(i) a comparative analysis of current Medicaid reimbursement rates and rates paid by
94other comparable payers, including Medicare, where applicable;
95(ii) the length of time since the last rate increase for the Medicaid provider type; and
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96(iii) an analysis of the impact of inventive payments on the Medicaid provider type.
97(c) In each year in which incentive payments are distributed as described in this section,
98the department shall annually, before October 31, report to the Social Services
99Appropriations Subcommittee on the distribution of incentive payments as described
100in Subsection (6), including on what percentage of an appropriation under this section
101was distributed directly to Medicaid providers.
102   (5)(a) Subject to appropriations from the Legislature for this purpose, and the
103Legislature's determination of eligible Medicaid provider types for the following
104fiscal year, a participating Medicaid provider may be eligible for incentive payments
105based on the participating Medicaid provider's performance as evaluated by the
106department as described in Subsection (3)(a)(ii).
107(b) The department may use up to 2% of an appropriation under this section for costs
108related to the administration of the provisions of this section.
109   (6) The department shall ensure that incentive payments are distributed:
110(a) proportionally to participating Medicaid providers;
111(b) in accordance with legislative appropriations; and
112(c) in accordance with CMS rules and regulations.
113   (7) The department may apply for necessary CMS authority to implement this section.
114Section 2. Section 26B-3-144 is enacted to read:
11526B-3-144 . Closed loop referral system.
116   (1) As used in this section:
117(a) "Authorized user" means a social needs care provider authorized by rules the
118department makes to use a closed loop referral system.
119(b) "Closed loop referral system" means a system that enables efficient outreach,
120engagement, and care coordination across cross-sector social needs care providers.
121(c) "Social needs care" means community-level services and supports that address
122health-related social needs.
123(d) "Social needs care provider" means a person that contracts with the department,
124directly or indirectly, to provide social needs care, including a:
125(i) government entity;
126(ii) healthcare organization;
127(iii) community organization; or
128(iv) social service organization.
129   (2) The department shall implement a closed loop referral system for referrals for the
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130      delivery of social care to Medicaid-eligible individuals.
131  (3) The department shall ensure that the closed loop referral system:
132      (a) notifies authorized users of social needs care requests and referrals;
133      (b) allows authorized users to securely access relevant information related to the social
134care needs of individuals the authorized user serves;
135      (c) allows an individual's information to be accessed only with the individual's consent
136and consistent with applicable privacy laws;
137      (d) facilitates communication between referring social needs care providers using a
138secure chat function;
139      (e) sends social needs care referrals on behalf of an individual receiving social needs
140care; and
141      (f) in a single record, tracks and stores:
142(i) the outcome of a referral; and
143(ii) the outcome of services delivered to an individual.
144  (4) The department shall make rules in accordance with Title 63G, Chapter 3, Utah
145      Administrative Rulemaking Act, to implement this section, including rules to establish
146      authorized use and authorized users of the closed loop referral system.
147Section 3. Section 26B-6-403 is amended to read:
14826B-6-403 . Responsibility and authority of division.
149  (1) For purposes of this section "administer" means to:
150      (a) plan;
151      (b) develop;
152      (c) manage;
153      (d) monitor; and
154      (e) conduct certification reviews.
155  (2) The division has the authority and responsibility to:
156      (a) administer an array of services and supports for persons with disabilities and their
157families throughout the state;
158      (b) make rules in accordance with Title 63G, Chapter 3, Utah Administrative
159Rulemaking Act, that establish eligibility criteria for the services and supports
160described in Subsection (2)(a);
161      (c) consistent with Section 26B-6-506, supervise the programs and facilities of the
162Developmental Center;
163      (d) in order to enhance the quality of life for a person with a disability, establish either
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164directly, or by contract with private, nonprofit organizations, programs of:
165(i) outreach;
166(ii) information and referral;
167(iii) prevention;
168(iv) technical assistance; and
169(v) public awareness;
170(e) supervise the programs and facilities operated by, or under contract with, the division;
171(f) cooperate with other state, governmental, and private agencies that provide services
172to a person with a disability;
173(g) subject to Subsection (3), ensure that a person with a disability is not deprived of that
174person's constitutionally protected rights without due process procedures designed to
175minimize the risk of error when a person with a disability is admitted to an
176intermediate care facility for people with an intellectual disability, including:
177(i) the developmental center; and
178(ii) facilities within the community;
179(h) determine whether to approve providers;
180(i) monitor and sanction approved providers, as specified in the providers' contract;
181(j) subject to Section 26B-6-410, receive and disburse public funds;
182(k) review financial actions of a provider who is a representative payee appointed by the
183Social Security Administration;
184(l) establish standards and rules for the administration and operation of programs
185conducted by, or under contract with, the division;
186(m) approve and monitor division programs to insure compliance with the board's rules
187and standards;
188(n) establish standards and rules necessary to fulfill the division's responsibilities under
189Part 5, Utah State Developmental Center, and Part 6, Admission to an Intermediate
190Care Facility for People with an Intellectual Disability, with regard to an intermediate
191care facility for people with an intellectual disability;
192(o) assess and collect equitable fees for a person who receives services provided under
193this chapter;
194(p) maintain records of, and account for, the funds described in Subsection (2)(o);
195(q) establish and apply rules to determine whether to approve, deny, or defer the
196division's services to a person who is:
197(i) applying to receive the services; or
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198(ii) currently receiving the services;
199      (r) in accordance with state law, establish rules:
200(i) relating to an intermediate care facility for people with an intellectual disability
201that is an endorsed program; and
202(ii) governing the admission, transfer, and discharge of a person with a disability;
203      (s) manage funds for a person residing in a facility operated by the division:
204(i) upon request of a parent or guardian of the person; or
205(ii) under administrative or court order; and
206      (t) fulfill the responsibilities described in Section 26B-1-430.
207  (3) The due process procedures described in Subsection (2)(g):
208      (a) shall include initial and periodic reviews to determine the constitutional
209appropriateness of the placement; and
210      (b) with regard to facilities in the community, do not require commitment to the division.
211  (4) Except as provided in Subsection (5), when the division makes amendments to a
212      contract the division enters into under Subsection (2), the division shall notify a provider
213      under contract with the division at least 30 days before the effective date of the
214      amendments.
215  (5) The division may waive the 30-day notice requirement described in Subsection (4):
216      (a) if a contractor requests a contract change;
217      (b) if a service rate is increased; or
218      (c) in response to a natural disaster or public health emergency.
219Section 4. FY 2027 Appropriations.
220The following sums of money are appropriated for the fiscal year beginning July 1,
221  2026, and ending June 30, 2027. These are additions to amounts previously appropriated for
222  fiscal year 2027.
223Subsection 4(a). Operating and Capital Budgets
224Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, the
225  Legislature appropriates the following sums of money from the funds or accounts indicated for
226  the use and support of the government of the state of Utah.
227  ITEM 1      To Department of Health and Human Services - Integrated Health Care Services
228From General Fund  3,925,900
229From Federal Funds  6,752,900
230Schedule of Programs:
231Medicaid Accountable Care Organizations  1,319,800
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232Medicaid Home and Community Based Services  5,275,000
233Medicaid Other Services  4,084,000
234The Legislature intends that the Department of
235Health and Human Services use:
236(1) $1,925,900 ongoing General Fund
237appropriation in this item to raise Medicaid provider rates
238for private duty nursing.
239(2) $2,000,000 ongoing General Fund
240appropriation in this item to raise Medicaid provider rates
241for the New Choices Waiver.
242   ITEM 2   To Department of Health and Human Services - Long-Term Services & Support
243From General Fund  4,162,700
244From Federal Funds  6,548,500
245Schedule of Programs:
246Aging Waiver Services  162,700
247Community Supports Waiver Services  10,548,500
248The Legislature intends that the Department of
249Health and Human Services use:
250(1) $4,000,000 ongoing General Fund
251appropriation in this item to raise Medicaid provider
252reimbursement rates for the Division of Services for
253People with Disabilities providers, excluding the Limited
254Supports Waiver providers, and including support
255coordinators.
256(2) $162,700 ongoing General Fund
257appropriation in this item to raise provider
258reimbursement rates for personal care.
259   ITEM 3   To Department of Health and Human Services - Children, Youth, & Families
260From General Fund  2,000,000
261Schedule of Programs:
262Child & Family Services  2,000,000
263The Legislature intends that the Department of
264Health and Human Services use the $2,000,000 ongoing
265General Fund appropriation in this item to raise provider
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266reimbursement rates for the proctor, congregate, and
267foster care providers housing foster children.
268  ITEM 4     To Department of Health and Human Services - Integrated Health Care Services
269From General Fund  6,799,700
270From Federal Funds  12,588,600
271Schedule of Programs:
272Medicaid Accountable Care Organizations  902,900
273Medicaid Home and Community Based Services  7,107,100
274Medicaid Long Term Care Services  7,911,400
275Medicaid Other Services  3,226,300
276Expansion Accountable Care Organizations  47,900
277Expansion Other Services  192,700
278The Legislature intends that the Department of
279Health and Human Services use:
280(1) $3,000,000 ongoing General Fund
281appropriation in this item to raise Medicaid provider
282reimbursement rates for nursing homes and intermediate
283care facilities for individuals with intellectual disabilities.
284(2) $1,962,400 ongoing General Fund
285appropriation in this item to raise Medicaid provider
286reimbursement rates for home health.
287(3) $1,837,300 ongoing General Fund
288appropriation in this item to raise Medicaid provider
289reimbursement rates for personal care.
290Section 5. Effective Date.
291  This bill takes effect on May 6, 2026.
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