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Committee approves amendment to S.36 to add 'medically necessary' standard for Medicaid-funded residential substance use stays
Summary
The Appropriations Committee moved S.36 to the floor after adding language that ties Medicaid payment for residential substance use treatment to a 'medically necessary' determination and asks AHS for a report on payment structures.
The Senate Appropriations Committee on March 19 voted to move S.36 to the floor with an amendment adding the phrase "medically necessary" to the bill's definition of episode-based Medicaid payments for residential substance use treatment when a co-occurring mental health disorder is present.
Katie McGlenn of the Office of Legislative Counsel explained the bill's purpose to the committee: S.36 changes how Medicaid pays for residential stays for substance use treatment, distinguishing high-intensity and low-intensity residential care and asking that providers make decisions about appropriate length of stay. "What this bill addresses is how Medicaid pays for residential stays of substance use treatment, when there's a co-occurring mental health disorder," McGlenn said, adding that current payment is structured by episode at an average of about 14 days and that the committee debated appropriate lengths of stay.
McGlenn told the committee the amendment inserting "medically necessary" would likely be budget neutral because it preserves the current clinical gatekeeping that determines who receives services. The bill also requires AHS to prepare a report reviewing Medicaid payment methodology for residential treatment and may include other related statutory adjustments noted in testimony.
A motion to move S.36 favorably to the floor was made and seconded in committee. The clerk recorded affirmative votes from multiple members, and the bill advanced to floor consideration with the committee amendment.
