UT Code § 26-18-405.5 (2021)
2021 Utah Code|Title 26 - Utah Health Code|Chapter 18 - Medical Assistance Act|Part 4 - Medicaid Waiver|Section 405.5 - Base budget appropriations for Medicaid accountable care organizations and mental health plans.

 Effective 7/1/2022  26-18-405.5. Base budget appropriations for Medicaid accountable care organizations and mental health plans.    (1) As used in this section:   (a) "ACO" means an accountable care organization that contracts with the state's Medicaid program for:   (i) physical health services; or     (ii) integrated physical and behavioral health services.       (b) "Base budget" means the same as that term is defined in legislative rule.     (c) "General Fund growth factor" means the amount determined by dividing the next fiscal year ongoing General Fund revenue estimate by current fiscal year ongoing appropriations from the General Fund.     (d) "Mental health plan" means a prepaid mental health plan or a health plan that uses a fee-for-service payment model that contracts with the state's Medicaid program for behavioral health services.     (e) "Next fiscal year ongoing General Fund revenue estimate" means the next fiscal year ongoing General Fund revenue estimate identified by the Executive Appropriations Subcommittee, in accordance with legislative rule, for use by the Office of the Legislative Fiscal Analyst in preparing budget recommendations.     (f) "PMPM" means per-member-per-month funding.       (2) If the General Fund growth factor is less than 100%, the next fiscal year base budget shall include an appropriation:   (a) to the department for ACOs under the department in an amount necessary to ensure that the next fiscal year PMPM for the ACOs equals the current fiscal year PMPM for the ACOs multiplied by 100%; and     (b) subject to Subsection (5), to the Department of Human Services for mental health plans under the Department of Human Services in an amount necessary to ensure that the funding for the mental health plans in the next fiscal year equals the funding for the mental health plans in the current fiscal year multiplied by 100%.       (3) If the General Fund growth factor is greater than or equal to 100%, but less than 102%, the next fiscal year base budget shall include an appropriation:   (a) to the department for ACOs under the department in an amount necessary to ensure that the next fiscal year PMPM for the ACOs equals the current fiscal year PMPM for the ACOs multiplied by the General Fund growth factor; and     (b) subject to Subsection (5), to the Department of Human Services for mental health plans under the Department of Human Services in an amount necessary to ensure that the funding for the mental health plans in the next fiscal year equals the funding for the mental health plans in the current fiscal year multiplied by the General Fund growth factor.       (4) If the General Fund growth factor is greater than or equal to 102%, the next fiscal year base budget shall include an appropriation:   (a) to the department for ACOs under the department in an amount necessary to ensure that the next fiscal year PMPM for the ACOs is greater than or equal to the current fiscal year PMPM for the ACOs multiplied by 102% and less than or equal to the current fiscal year PMPM for the ACOs multiplied by the General Fund growth factor; and     (b) subject to Subsection (5), to the Department of Human Services for mental health plans under the Department of Human Services in an amount necessary to ensure that the funding for the mental health plans in the next fiscal year is greater than or equal to the funding for the mental health plans in the current fiscal year multiplied by 102% and less than or equal to the funding for the mental health plans in the current fiscal year multiplied by the General Fund growth factor.       (5) The appropriations provided to the Department of Human Services under this section shall be reduced by the amount contributed by counties in the current fiscal year for mental health plans under the Department of Human Services in accordance with Subsections 17-43-201(5)(k) and 17-43-301(6)(a)(x).     (6) In order for the department and the Department of Human Services to estimate the impact of Subsections (2) through (4) before identification of the next fiscal year ongoing General Fund revenue estimate, the Governor's Office of Planning and Budget shall, in cooperation with the Office of the Legislative Fiscal Analyst, develop an estimate of ongoing General Fund revenue for the next fiscal year and provide the estimate to the department and the Department of Human Services no later than November 1 of each year.    Amended by Chapter 404, 2021 General Session