H.F. 446 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 consistent with the community mental health system 7 provider type. The department shall reimburse the integrated 8 network provider type consistent with the Medicaid community 9 mental health center enhanced fee schedule beginning January 10 1, 2022. 11 Sec. 2. EMERGENCY RULES. The department may adopt emergency 12 rules under section 17A.4, subsection 3, and section 17A.5, 13 subsection 2, paragraph “b”, to administer the provisions of 14 this division. Any rules adopted in accordance with this 15 section shall also be published as a notice of intended action 16 as provided in section 17A.4. 17 Sec. 3. EFFECTIVE DATE. This division of this Act, being 18 deemed of immediate importance, takes effect upon enactment. 19 DIVISION II 20 SUBSTANCE USE DISORDER TREATMENT SERVICES AND BEHAVIORAL HEALTH 21 SERVICES PROVIDERS —— REIMBURSEMENTS 22 Sec. 4. SUBSTANCE USE DISORDER TREATMENT SERVICES AND 23 BEHAVIORAL HEALTH SERVICES PROVIDERS —— REIMBURSEMENTS. 24 1. The department of public health in collaboration 25 with the department of human services shall review and make 26 recommendations for Medicaid 1915(b)(3) waiver reimbursement 27 rates for substance use disorder intensive outpatient and 28 residential treatment services using a projected cost report 29 agreed upon by the departments and the integrated provider 30 network providers. The departments shall establish time frames 31 for release of the agreed-upon projected cost report form to 32 providers and the deadline for submission of the completed 33 projected cost reports by providers to the departments, in 34 order to allow sufficient time for review and the making of 35 -1- LSB 2393YH (3) 89 pf/rh 1/ 6

H.F. 446 recommended adjustments to the Medicaid 1915(b)(3) waiver 1 reimbursement rates for Medicaid integrated provider network 2 providers beginning July 1, 2022. 3 2. The department of public health in collaboration with 4 the department of human services and behavioral health services 5 providers shall review reimbursement rates for behavioral 6 health services and Medicaid 1915(b)(3) waiver services using 7 the projected cost report agreed upon by the departments and 8 the integrated provider network providers. The departments 9 shall establish time frames for release of the agreed-upon 10 projected cost report form to behavioral health services 11 providers and the deadline for submission of the completed 12 projected cost reports by behavioral health services providers 13 to the departments, in order to allow sufficient time for the 14 departments to review and make recommended adjustments to 15 the Medicaid 1915(b)(3) waiver reimbursement rates and the 16 behavioral health services fee schedule beginning July 1, 2022. 17 3. The department of public health, in collaboration with 18 the department of human services, shall establish an ongoing 19 plan for regular review of reimbursements for providers of 20 substance use disorder treatment services and behavioral health 21 services and provide information to the governor and the 22 general assembly in a timely manner to allow for the provision 23 of appropriate funding for any change in reimbursements. 24 Sec. 5. EMERGENCY RULES. The department may adopt emergency 25 rules under section 17A.4, subsection 3, and section 17A.5, 26 subsection 2, paragraph “b”, to administer the provisions of 27 this division. Any rules adopted in accordance with this 28 section shall also be published as a notice of intended action 29 as provided in section 17A.4. 30 Sec. 6. EFFECTIVE DATE. This division of this Act, being 31 deemed of immediate importance, takes effect upon enactment. 32 DIVISION III 33 MEDICATION-ASSISTED TREATMENT 34 Sec. 7. MEDICATION-ASSISTED TREATMENT —— PRIOR 35 -2- LSB 2393YH (3) 89 pf/rh 2/ 6

H.F. 446 AUTHORIZATION PROHIBITED. The department of human services 1 shall adopt rules pursuant to chapter 17A that prohibit prior 2 authorization for medication-assisted treatment under both 3 Medicaid fee-for-service or managed care administration. 4 The department of human services shall also include this 5 prohibition in any contract entered into with a Medicaid 6 managed care organization. For the purposes of this 7 section, “medication-assisted treatment” means the medically 8 monitored use of certain substance use disorder medications in 9 combination with other treatment services. 10 Sec. 8. EMERGENCY RULES. The department may adopt emergency 11 rules under section 17A.4, subsection 3, and section 17A.5, 12 subsection 2, paragraph “b”, to administer the provisions of 13 this division. Any rules adopted in accordance with this 14 section shall also be published as a notice of intended action 15 as provided in section 17A.4. 16 Sec. 9. EFFECTIVE DATE. This division of this Act, being 17 deemed of immediate importance, takes effect upon enactment. 18 DIVISION IV 19 SUBSTANCE USE DISORDER ADVISORY PANEL 20 Sec. 10. SUBSTANCE USE DISORDER ADVISORY PANEL. The 21 department of public health in collaboration with the 22 department of human services shall establish a substance use 23 disorder advisory panel to review access to substance use 24 disorder services and to resolve barriers to access. The 25 members of the advisory panel shall include but are not 26 limited to representatives of hospital-affiliated substance use 27 disorder treatment programs, the integrated provider network, 28 and others with interest or expertise in substance use disorder 29 treatment services and reimbursement. 30 DIVISION V 31 MEDICAID WAIVER OPPORTUNITIES 32 Sec. 11. MEDICAID WAIVER OPPORTUNITIES. The department of 33 human services in collaboration with the department of public 34 health shall review opportunities including application for 35 -3- LSB 2393YH (3) 89 pf/rh 3/ 6

H.F. 446 the federal Medicaid 1115 demonstration waiver or amendments 1 to the existing federal Medicaid 1915(b) waiver to enhance 2 access to and reimbursement for substance use disorder 3 treatment services. The departments shall report findings and 4 recommendations to the governor and the general assembly by 5 October 1, 2021. 6 EXPLANATION 7 The inclusion of this explanation does not constitute agreement with 8 the explanation’s substance by the members of the general assembly. 9 This bill relates to reimbursement rates for providers of 10 substance use disorder treatment services and behavioral health 11 services. 12 Division I of the bill requires the department of human 13 services (DHS) to establish an integrated provider network 14 provider as a participating provider type under the Medicaid 15 program consistent with the community mental health system 16 provider type. The division requires DHS to reimburse 17 the integrated network provider type consistent with the 18 Medicaid community mental health center enhanced fee schedule 19 beginning January 1, 2022. The division provides for emergency 20 rulemaking and takes effect upon enactment. 21 Division II of the bill relates to reimbursement rates 22 for providers of substance use disorder treatment services 23 and behavioral health services. The division requires the 24 department of public health (DPH), in collaboration with DHS, 25 to review and make recommendations for Medicaid 1915(b)(3) 26 waiver reimbursement rates for substance use disorder intensive 27 outpatient and residential treatment services using a projected 28 cost report agreed upon by the departments and the integrated 29 provider network providers. The departments are required 30 to establish time frames for release of the agreed-upon 31 projected cost report form to providers and the deadline for 32 submission of the completed projected cost reports by providers 33 to the departments, to allow sufficient time for review and 34 adjustments to reimbursement rates for Medicaid integrated 35 -4- LSB 2393YH (3) 89 pf/rh 4/ 6

H.F. 446 provider network service providers beginning July 1, 2022. 1 The division also requires DPH, in collaboration with DHS and 2 behavioral health services providers, to review reimbursement 3 rates for behavioral health services and Medicaid 1915(b)(3) 4 waiver services using the projected cost report agreed 5 upon. Again, the departments shall establish time frames and 6 deadlines for the cost reports to allow sufficient time for 7 the departments to review and make recommended adjustments to 8 the reimbursement rates and the behavioral health services fee 9 schedule beginning July 1, 2022. The division directs DPH 10 in collaboration with DHS to establish an ongoing plan for 11 regular review of reimbursements for providers of substance 12 use disorder treatment services and behavioral health services 13 and to provide information to the governor and the general 14 assembly in a timely manner to allow for the provision of 15 appropriate funding for any change in reimbursements. The 16 division provides for emergency rulemaking and takes effect 17 upon enactment. 18 Division III of the bill requires DHS to adopt 19 administrative rules to prohibit prior authorization for 20 the provision of medication-assisted treatment under either 21 Medicaid fee-for-service or managed care administration. 22 The division also requires DHS to include this prohibition 23 in any contract entered into with a Medicaid managed care 24 organization. Under the division, “medication-assisted 25 treatment” means the medically monitored use of certain 26 substance use disorder medications in combination with other 27 treatment services. The division provides for emergency 28 rulemaking and takes effect upon enactment. 29 Division IV of the bill requires DPH in collaboration 30 with DHS to establish an advisory panel to review access to 31 substance use disorder services and to resolve barriers to 32 access. The members of the advisory panel include but are not 33 limited to representatives of hospital-affiliated substance use 34 disorder treatment programs, the integrated provider network, 35 -5- LSB 2393YH (3) 89 pf/rh 5/ 6

H.F. 446 and others with interest or expertise in substance use disorder 1 treatment services and reimbursement. 2 Division V of the bill directs DHS in collaboration with 3 DPH to review opportunities including application for a 4 federal Medicaid 1115 demonstration waiver or amendments 5 to the existing federal Medicaid 1915(b) waiver to enhance 6 access to and reimbursement for substance use disorder 7 treatment services. The departments shall report findings and 8 recommendations to the governor and the general assembly by 9 October 1, 2021. 10 -6- LSB 2393YH (3) 89 pf/rh 6/ 6