Bill > SB0246

This bill modifies the state's Medicaid reimbursement rate calculation methodology, focusing on how base budget appropriations are determined for Medicaid accountable care organizations (ACOs), behavioral health plans, and applied behavior analysis (ABA) services. The bill establishes a complex formula for calculating per-member-per-month (PMPM) funding based on the General Fund growth factor, with different rules applying depending on whether the growth factor is less than, equal to, or greater than 100%. For fiscal years 2026 and 2027, if the growth factor is 102% or higher, the bill requires allocating appropriations to provide similar percentage increases to ACOs, behavioral health plans, and ABA service reimbursement rates. From fiscal year 2028 onward, the PMPM increases are capped at 102% but cannot exceed the General Fund growth factor. The bill also requires the Governor's Office of Planning and Budget to estimate ongoing General Fund revenue and provide this estimate to the department by November 1 each year. The legislation aims to provide more predictable and potentially increased funding for Medicaid-related healthcare services, with a specific effective date of May 7, 2025.

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https://le.utah.gov/~2025/bills/static/SB0246.html