Relating to substance use disorder treatment and behavioral health services and reimbursement, and including effective date provisions

This bill relates to reimbursement rates for providers of substance use disorder treatment services and behavioral health services. Division I of the bill requires the department of human services (DHS) to establish an integrated provider network provider as a participating provider type under the Medicaid program consistent with the community mental health system provider type. The division requires DHS to reimburse the integrated network provider type consistent with the Medicaid community mental health center enhanced fee schedule beginning January 1, 2022. The division provides for emergency rulemaking and takes effect upon enactment. Division II of the bill relates to reimbursement rates for providers of substance use disorder treatment services and behavioral health services. The division requires the department of public health (DPH), in collaboration with DHS, to review and make recommendations for Medicaid 1915(b)(3) waiver reimbursement rates for substance use disorder intensive outpatient and residential treatment services using a projected cost report agreed upon by the departments and the integrated provider network providers. The departments are required to establish time frames for release of the agreed-upon projected cost report form to providers and the deadline for submission of the completed projected cost reports by providers to the departments, to allow sufficient time for review and adjustments to reimbursement rates for Medicaid integrated provider network service providers beginning July 1, 2022. The division also requires DPH, in collaboration with DHS and behavioral health services providers, to review reimbursement rates for behavioral health services and Medicaid 1915(b)(3) waiver services using the projected cost report agreed upon. Again, the departments shall establish time frames and deadlines for the cost reports to allow sufficient time for the departments to review and make recommended adjustments to the reimbursement rates and the behavioral health services fee schedule beginning July 1, 2022. The division directs DPH in collaboration with DHS to establish an ongoing plan for regular review of reimbursements for providers of substance use disorder treatment services and behavioral health services and to provide information to the governor and the general assembly in a timely manner to allow for the provision of appropriate funding for any change in reimbursements. The division provides for emergency rulemaking and takes effect upon enactment. Division III of the bill requires DHS to adopt administrative rules to prohibit prior authorization for the provision of medication-assisted treatment under either Medicaid fee-for-service or managed care administration. The division also requires DHS to include this prohibition in any contract entered into with a Medicaid managed care organization. Under the division, “medication-assisted treatment” means the medically monitored use of certain substance use disorder medications in combination with other treatment services. The division provides for emergency rulemaking and takes effect upon enactment. Division IV of the bill requires DPH in collaboration with DHS to establish an advisory panel to review access to substance use disorder services and to resolve barriers to access. The members of the advisory panel include but are not limited to representatives of hospital-affiliated substance use disorder treatment programs, the integrated provider network, and others with interest or expertise in substance use disorder treatment services and reimbursement. Division V of the bill directs DHS in collaboration with DPH to review opportunities including application for a federal Medicaid 1115 demonstration waiver or amendments to the existing federal Medicaid 1915(b) waiver to enhance access to and reimbursement for substance use disorder treatment services. The departments shall report findings and recommendations to the governor and the general assembly by October 1, 2021.