53-21-701. Mental health managed care -- contract -- advisory council. (1) The department of public health and human services shall incrementally develop managed care systems for recipients of public mental health services. The department may contract with one or more persons for the management of comprehensive mental health services for medicaid recipients and for persons as specified in 53-6-131(10). The department may contract for the provision of these services by means of a fixed monetary or capitated amount per recipient. The department shall ensure that each contractor that assumes risk is required to comply with the provisions of Title 53, chapter 6, part 7, for the medicaid portion of the program.
     (2) A managed care system is a program organized to serve the mental health needs of recipients in an efficient and cost-effective manner by managing the receipt of mental health care and services for a geographical or otherwise defined population of recipients through appropriate health care professionals. The management of mental health care services must provide for services in the most cost-effective manner through coordination and management of the appropriate level of care and appropriate level of services. The managed care system shall review and determine the appropriate level of services on an individual basis in order to ensure that access to care, quality of care, and the cost of the program are maintained.
     (3) The department may enter into one or more contracts with managed care entities for the administration or delivery of mental health services. These contracts may be based upon a fixed monetary amount or a capitated amount per individual, and a contractor may assume all or a part of the financial risk of providing services to a set population of eligible individuals. The department may require the participation of recipients in managed care systems based upon geographical, financial, medical, or other factors that the department may determine are relevant to the development and efficient operation of the managed care systems.
     (4) The department may establish eligibility requirements, resource and income standards, premiums, fees, and copayments. Eligible individuals may not have a family income that exceeds the amount established pursuant to 53-6-131(10).
     (5) The department shall establish the amount, scope, and duration of services to be provided under the program. The services to be provided and eligibility requirements may be more limited than those in the medicaid program under chapter 6.
     (6) (a) The department shall form an advisory council, to be known as the mental health oversight advisory council, that is not subject to 2-15-122 to provide input to the department in the development and management of any public mental health system. The advisory council membership must include:
     (i) one-half of the members as consumers of mental health services, including persons with serious mental illnesses who are receiving public mental health services, other recipients of mental health services, former recipients of public mental health services, and immediate family members of recipients of mental health services; and
     (ii) advocates for consumers or family members of consumers, members of the public at large, providers of mental health services, legislators, department representatives, and a representative of the commissioner of insurance.
     (b) The advisory council under this section may be administered so as to fulfill any federal advisory council requirements to obtain federal funds for this program.
     (c) Geographic representation must be considered when appointing members to the advisory council in order to provide as wide a representation as possible.
     (d) The advisory council shall provide a summary of each meeting and a copy of any recommendations made to the department to the legislative finance committee and any other designated appropriate legislative interim committee. The department shall provide the same committees with the department's rationale for not accepting or implementing any recommendation of the advisory council.
     (7) The department shall formally evaluate contract performance with regard to specific outcome measures. The department shall explicitly identify performance and outcome measures that contractors are required to achieve in order to comply with contract requirements and to continue the contract. The contract must provide for progressive intermediate sanctions that may be imposed for nonperformance. The evaluation must be performed at least annually.

     History: En. Sec. 6, Ch. 577, L. 1999.