H.F. 577 DIVISION I 1 INTEGRATED PROVIDER NETWORK PROVIDERS —— REIMBURSEMENT 2 Section 1. INTEGRATED PROVIDER NETWORK PROVIDERS —— 3 MEDICAID PROVIDERS —— REIMBURSEMENT. The department of 4 human services shall establish an integrated provider network 5 provider as a participating provider type under the Medicaid 6 program comparable to the integrated provider network providers 7 under contract with the department of public health. The 8 department shall designate and utilize the Medicaid community 9 mental health center enhanced fee schedule as the minimum 10 reimbursement for services provided by Medicaid integrated 11 provider network providers. 12 Sec. 2. EMERGENCY RULES. The department may adopt emergency 13 rules under section 17A.4, subsection 3, and section 17A.5, 14 subsection 2, paragraph “b”, to administer the provisions of 15 this division. Any rules adopted in accordance with this 16 section shall also be published as a notice of intended action 17 as provided in section 17A.4. 18 Sec. 3. EFFECTIVE DATE. This division of this Act, being 19 deemed of immediate importance, takes effect upon enactment. 20 DIVISION II 21 BEHAVIORAL HEALTH SERVICES —— REIMBURSEMENT 22 Sec. 4. SUBSTANCE USE DISORDER —— INTENSIVE OUTPATIENT AND 23 RESIDENTIAL TREATMENT —— REIMBURSEMENT. 24 1. For the fiscal year beginning July 1, 2019, the 25 department of human services shall establish reimbursement 26 rates for substance use disorder intensive outpatient and 27 residential treatment services provided under a Medicaid 28 1915(b)(3) waiver in alignment with the reimbursement rates 29 provided for the same services under the substance abuse 30 prevention and treatment block grant awarded by the United 31 States department of health and human services substance abuse 32 and mental health services administration and administered by 33 the department of public health. 34 2. The department of public health in collaboration 35 -1- LSB 2617HH (3) 88 pf/rh 1/ 6

H.F. 577 with the department of human services shall review and make 1 recommendations for Medicaid 1915(b)(3) waiver reimbursement 2 rates for substance use disorder intensive outpatient and 3 residential treatment services using a projected cost report 4 agreed upon by the departments and the integrated provider 5 network providers. The departments shall establish time frames 6 for release of the agreed-upon projected cost report form to 7 providers and the deadline for submission of the completed 8 projected cost reports by providers to the departments, in 9 order to allow sufficient time for review and the making of 10 recommended adjustments to the Medicaid 1915(b)(3) waiver 11 reimbursement rates for Medicaid integrated provider network 12 providers effective January 1, 2020. 13 3. The department of public health in collaboration with the 14 department of human services and behavioral health providers 15 shall review reimbursement rates for behavioral health services 16 and Medicaid 1915(b)(3) waiver services using the projected 17 cost report agreed upon by the departments and the integrated 18 provider network providers. The departments shall establish 19 time frames for release of the agreed-upon projected cost 20 report form to behavioral health providers and the deadline 21 for submission of the completed projected cost reports by 22 behavioral health providers to the departments, in order to 23 allow sufficient time for the departments to review and make 24 recommended adjustments to the Medicaid 1915(b)(3) waiver 25 reimbursement rates and the behavioral health services fee 26 schedule effective July 1, 2020. 27 4. The department of public health in collaboration with the 28 department of human services shall establish an ongoing plan 29 for regular review of reimbursement for substance use disorder 30 treatment and to provide information to the governor and the 31 general assembly in a timely manner to allow for provision of 32 appropriate funding for any change in reimbursement. 33 Sec. 5. EMERGENCY RULES. The department may adopt emergency 34 rules under section 17A.4, subsection 3, and section 17A.5, 35 -2- LSB 2617HH (3) 88 pf/rh 2/ 6

H.F. 577 subsection 2, paragraph “b”, to administer the provisions of 1 this division. Any rules adopted in accordance with this 2 section shall also be published as a notice of intended action 3 as provided in section 17A.4. 4 Sec. 6. EFFECTIVE DATE. This division of this Act, being 5 deemed of immediate importance, takes effect upon enactment. 6 DIVISION III 7 MEDICATION-ASSISTED TREATMENT 8 Sec. 7. MEDICATION-ASSISTED TREATMENT —— PRIOR 9 AUTHORIZATION PROHIBITED. The department of human services 10 shall adopt rules pursuant to chapter 17A that prohibit prior 11 authorization for medication-assisted treatment under both 12 Medicaid fee-for-service or managed care administration. 13 The department of human services shall also include this 14 prohibition in any contract entered into with a Medicaid 15 managed care organization. For the purposes of this 16 section, “medication-assisted treatment” means the medically 17 monitored use of certain substance use disorder medications in 18 combination with other treatment services. 19 Sec. 8. EMERGENCY RULES. The department may adopt emergency 20 rules under section 17A.4, subsection 3, and section 17A.5, 21 subsection 2, paragraph “b”, to administer the provisions of 22 this division. Any rules adopted in accordance with this 23 section shall also be published as a notice of intended action 24 as provided in section 17A.4. 25 Sec. 9. EFFECTIVE DATE. This division of this Act, being 26 deemed of immediate importance, takes effect upon enactment. 27 DIVISION IV 28 SUBSTANCE USE DISORDER ADVISORY PANEL 29 Sec. 10. SUBSTANCE USE DISORDER ADVISORY PANEL. The 30 department of public health in collaboration with the 31 department of human services shall establish a substance use 32 disorder advisory panel to review access to substance use 33 disorder services and to resolve barriers to access. The 34 members of the advisory panel shall include but are not 35 -3- LSB 2617HH (3) 88 pf/rh 3/ 6

H.F. 577 limited to representatives of hospital-affiliated substance use 1 disorder treatment programs, the integrated provider network, 2 and others with interest or expertise in substance use disorder 3 treatment services and reimbursement. 4 DIVISION V 5 MEDICAID WAIVER OPPORTUNITIES 6 Sec. 11. MEDICAID WAIVER OPPORTUNITIES. The department of 7 human services in collaboration with the department of public 8 health shall review opportunities including application for 9 the federal Medicaid 1115 demonstration waiver or amendments 10 to the existing federal Medicaid 1915(b) waiver to enhance 11 access to and reimbursement for substance use disorder 12 treatment services. The departments shall report findings and 13 recommendations to the governor and the general assembly by 14 October 1, 2019. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill relates to substance use disorder services and 19 reimbursement. 20 Division I of the bill requires the department of human 21 services (DHS) to establish an integrated provider network 22 provider as a participating provider type under the Medicaid 23 program comparable to the integrated provider network providers 24 under contract with the department of public health (DPH). 25 The bill requires DHS to designate and utilize the Medicaid 26 community mental health center enhanced fee schedule as 27 the minimum reimbursement for services provided by Medicaid 28 integrated provider network providers. The division provides 29 for emergency rulemaking and takes effect upon enactment. 30 Division II of the bill relates to reimbursement of 31 behavioral health services. The bill requires that for 32 the fiscal year beginning July 1, 2019, DHS shall establish 33 reimbursement rates for substance use disorder intensive 34 outpatient and residential treatment services provided under a 35 -4- LSB 2617HH (3) 88 pf/rh 4/ 6

H.F. 577 Medicaid 1915(b)(3) waiver in alignment with the reimbursement 1 rates provided for the same services under the substance abuse 2 prevention and treatment block grant administered by DPH. 3 Additionally, Division II requires DPH in collaboration with 4 DHS to review and make recommendations for Medicaid 1915(b)(3) 5 waiver reimbursement rates for substance use disorder intensive 6 outpatient and residential treatment services using a projected 7 cost report agreed upon by the departments and the integrated 8 provider network providers. The departments are required 9 to establish time frames for release of the agreed-upon 10 projected cost report form to providers and the deadline 11 for submission of the completed projected cost reports by 12 providers to the departments, to allow sufficient time for 13 review and adjustments to reimbursement rates for Medicaid 14 integrated provider network service providers effective January 15 1, 2020. Division II also requires DPH in collaboration with 16 DHS and behavioral health providers to review reimbursement 17 rates for behavioral health services and Medicaid 1915(b)(3) 18 waiver services using the projected cost report agreed 19 upon. Again, the departments shall establish time frames and 20 deadlines for the cost reports to allow sufficient time for 21 the departments to review and make recommended adjustments to 22 the reimbursement rates and the behavioral health services 23 fee schedule effective July 1, 2020. Finally, the division 24 directs DPH in collaboration with DHS to establish an ongoing 25 plan for regular review of reimbursement for substance use 26 disorder treatment services and to provide information to the 27 governor and the general assembly in a timely manner to allow 28 for provision of appropriate funding for the next fiscal year. 29 The division provides for emergency rulemaking and takes effect 30 upon enactment. 31 Division III of the bill requires DHS to adopt 32 administrative rules to prohibit prior authorization for 33 the provision of medication-assisted treatment under either 34 Medicaid fee-for-service or managed care administration. 35 -5- LSB 2617HH (3) 88 pf/rh 5/ 6

H.F. 577 The division also requires DHS to include this prohibition 1 in any contract entered into with a Medicaid managed care 2 organization. Under the division, “medication-assisted 3 treatment” means the medically monitored use of certain 4 substance use disorder medications in combination with other 5 treatment services. The division provides for emergency 6 rulemaking and takes effect upon enactment. 7 Division IV of the bill requires DPH in collaboration 8 with DHS to establish an advisory panel to review access to 9 substance use disorder services and to resolve barriers to 10 access. The members of the advisory panel include but are not 11 limited to representatives of hospital-affiliated substance use 12 disorder treatment programs, the integrated provider network, 13 and others with interest or expertise in substance use disorder 14 treatment services and reimbursement. 15 Division V of the bill directs DHS in collaboration with 16 DPH to review opportunities including application for a 17 federal Medicaid 1115 demonstration waiver or amendments 18 to the existing federal Medicaid 1915(b) waiver to enhance 19 access to and reimbursement for substance use disorder 20 treatment services. The departments shall report findings and 21 recommendations to the governor and the general assembly by 22 October 1, 2019. 23 -6- LSB 2617HH (3) 88 pf/rh 6/ 6