UBHO post-session review
Hello all, and congrats on an extremely successful session in a tight budget year. While there were many bills and appropriations we were keeping an eye on, here is a summary of the issues we were most heavily involved in, including our wins and some recommendations going forward.
Bills
HB32 (Eliason)– This bill was at the top of our priority list throughout the session. Language was successfully added in the first and second substitute that sets up an oversight commission and ensures ACOs and MCOs are involved and consulted for various aspects of the receiving centers’ operations. As the funding for this bill was being worked out, it seemed to be a different number every week. Ultimately, however, we were able to get much more than anticipated. The total appropriation for this bill was approximately $10.8M ongoing and $5.9M one-time. That’s an incredible win given the budget process this year, and it should be enough to fund receiving centers in all four counties that submitted budgets and expressed interest (Salt Lake, Davis, Utah, Washington). The existing receiving center in Davis County, along with data from other states have already shown the substantial impact this will have on both the criminal justice and healthcare systems across the state. This is a huge win for us as providers, and perhaps an even bigger win for the people we serve that are stuck in the midst of debilitating mental illnesses and/or substance use disorders. Regardless of whether your census is weighted in the direction of public or private plan members, other states have shown that this system redefines access to treatment in about every way. As the population becomes aware of the access and assurance that criminal charges are not a factor, these centers become the hub for not only law enforcement and first responder drop offs, but also worried family members and all those clients in the middle class with individual or employee sponsored benefits that used to access care by going to emergency rooms. We are excited to see how this rolls out and look forward to being involved as much as possible.
HB35 (Eliason)– This was more or less a companion bill to HB32, we were able to get $6.2M ongoing for Assertive Community Treatment (ACT) teams and housing assistance programs for people leaving the State Hospital. this $6.2 added to HB32 probably makes Representative Eliason the biggest winner of the year when it comes to general fund money. During our conversations with members of EAC, both of these bills were favored by certain members of leadership that really made the funding possible.
HB436 (Dunnigan)– We met with Representative Dunnigan, DHS Office of Licensing, DSAMH, and others multiple times on this throughout the session. While Representative Watkins also had a bill to address background checks, we felt it didn’t go far enough and wanted this bill to get more needed changes. While they are necessary on some level, background checks on our employees continue to be an absurd burden, especially when they are required by multiple agencies at multiple times. They are also ten times worse for Mental Health programs than they are for SUD programs, so this bill sought to loosen those requirements and to ensure the discussion continues over the interim on ways we can make this process quicker and easier.
HB55 (Shurtliff)– I think we have now killed this bill four different times. For whatever reason, it continues to come up without the substantive changes needed to make it acceptable. We have exempted ourselves out of the bill, but it’s still such a bad policy change that we have continued to oppose it and ensure it doesn’t get past the first committee. To be clear, the problem Representative Shurtliff has brought up regarding “providers” and private probation companies trolling courtrooms to take advantage of offenders is absolutely real. This bill just simply isn’t the right way to address it, so we have had discussions with Representative Shurtliff about using Patient Brokering statute to address this problem, and we are open to working with her over the interim to come up with a bill that works.
HB38 (Daw)– We worked hand-in-hand with Representative Daw on this bill throughout the session. While we did end up having to make some concessions and drop the tax incentive and telehealth portions of the bill to ensure passage, we still got a huge win in the potential to get Medicaid coverage to inmates during the final 30 days of incarceration. If we’re able to get this waiver, the savings generated by Medicaid Match will have a substantial impact on our counties’ general funds and allow us to expand and enhance treatment efforts in correctional settings. Our recommendation would be to work with Representative Daw over the interim and potentially revive the telehealth pilot and tax incentives in a new bill next year.
HB219 (Dunnigan)– This bill sailed through the process with minimal opposition and there’s a pretty good chance we get the waiver. We got this waiver for the SUD population a couple years ago, and since that time we have seen an unbelievable expansion in capacity and reduction in waiting lists to access treatment. This waiver could actually have an even bigger impact for the mental health side, especially considering the increase in Medicaid enrollment now that we’re essentially at full expansion.
SB39 (Anderegg)– This bill was partially funded at $10M one-time, which is a nice chunk but well shy of the requested $35M. The legislature intends that $5M be used for gap financing on bond-financed multi-family housing, and the other $5M to be reserved and used to match private money for construction of low-income housing. The money will pass through DWS to the Olene Walker fund, where it will be made available.
In addition to funding the fiscal notes of these priority bills, here are the Line-Item Appropriations we worked to secure
Line-Item Appropriations
Behavioral Health Workforce Reinvestment – 3,200,000 (Sen. Henderson)– The total request on this was just over $5M, about $1.8M of which was ongoing. We were able to get a total of $3.2M, with $1.2M ongoing. This will have a huge impact on the shortage of clinicians in Utah. It will take a few years to have an impact, but we’ve been talking about this for a couple years now so it’s a big win to get this done.
MAT Program in Jails and Prison – $1,000,000 (Rep. Hutchings)– This is a continuation of the Long-Acting Naltrexone Pilot Program that has been going on in Salt Lake and Davis Counties for the past few years. As we have enacted TAM and Medicaid Expansion, the monthly doses of Medication post-release are now almost always covered by Medicaid. Because of this, this same amount of money can go much further to start Long-Acting Naltrexone Programs in the Prison and really any other county jail that wants to start one. Tim and Brandon have compiled data on recidivism rates as a result of these programs, and the numbers are astounding. If any UBHC members would like to work with local sheriffs to start a program in your own county jail(s), there is money available and we would be happy to help.
State Hospital – $4.8M 30-bed forensic unit + $881k Staff Salary increase (Gov)– this has been badly needed for years now and has been difficult because partial funding won’t work, this is another big win.
Comments These successes we had during the general session, along with the $3.9M supplemental restoration we got in December truly are extraordinary, especially considering the priority of leadership this year was to pick up the pieces of tax reform and get a deal in place allowing Education Fund money to be expanded to include certain programs for children and disabled adults (Most of these programs are currently funded out of Social Services’ GF allocation).
We hope everyone is staying safe during this COVID-19 Crisis. Most of the services we provide are considered essential services, but if anyone has to make difficult decisions with employees, there is both state and federal money available to help. The other major concern is that a special session to deal with this crisis is almost certain. The legislature will likely have to make some tough decisions to free up money for treatment of COVID-19 and the economic hardships associated with our preventative measures. There is a scant chance the Rainy Day Fund will cover this, so they will likely have to reallocate money. What this means for us, is that NONE of our appropriations are safe. We got some of the biggest pots of GF money and they will become an easy target for reallocation to the COVID-19 crisis, especially the new programs. There won’t be much we can do if it comes to a statewide emergency, so we will keep you posted and anything lost will be prioritized going forward. Thank you all for your work, and we look forward to seeing you all when things normalize and in-person meetings make sense again.
Thanks again,
-Joel