County staff ask permission to bill certain commercial exchange plans to preserve continuity of substance‑use treatment

Richard Nance, director of the Utah County Department of Drug and Alcohol Prevention and Treatment (DDAAP), asked the commission to reconsider an informal county philosophy of not competing with private providers by allowing DDAAP to bill certain commercial insurance plans tied to existing ACO contracts.

Nance said Medicaid expansion and reductions in state general‑fund dollars created a revenue gap in the department’s 2020 budget; the department is trying to avoid drawing reserves by pursuing other revenue options. He explained that many clients started on Medicaid as part of expansion can, within months of entering treatment, gain employment and transition onto exchange plans or commercial coverage. Because transfers to new providers disrupt continuity of care — with follow‑through rates around 50% for transfers — DDAAP seeks authority to bill four ACO plans where DDAAP is included as an in‑network provider so clients already in treatment can continue seamlessly rather than be transferred.

Nance stressed the department would not broadly market to commercial insured populations or try to compete for employer clients; the request is limited to clients DDAAP already serves who transition off Medicaid. Commissioners asked detailed questions about who falls into the 138% of poverty category, how private providers might serve those clients, and whether county billing would undercut private providers. Commissioners generally expressed openness to exploring the approach but asked Nance to meet with assigned commissioners and budget staff to work through operational details and safeguards before a policy change or written directive is made.

Nance and commissioners agreed to schedule follow‑up meetings to refine policy boundaries, review likely fiscal impact, and ensure legal/contractual compliance with the four ACO agreements already in place.