§ 53-21-1015 — Certified Community Behavioral Health Clinic Requirements -- Billing Practices -- Performance Measurements

53-21-1015 . Certified community behavioral health clinic requirements -- billing practices -- performance measurements. (1) In addition to the services required under federal law and regulation, a certified community behavioral health clinic shall directly provide the following services:
(a) targeted case management;
(b) peer and family caregiver services and supports; and
(c) outreach and education as specified in subsection (5).
(2) A certified community behavioral health clinic may directly provide or contract with a third party to provide the following services:
(a) primary care screening and monitoring;
(b) services for veterans and members of the armed forces; and
(c) outpatient psychiatric rehabilitation services.
(3) A certified community behavioral health clinic shall coordinate with other community-based service providers to prevent duplication of services and develop a continuum of services within the community.
(4) (a) If a screening indicates that a person is in urgent need of services, a certified community behavioral health clinic shall provide clinical services and an initial evaluation within 1 business day of the first contact with the patient.
(b) A certified community behavioral health clinic shall provide a new patient with a comprehensive person-centered and family-centered diagnostic and treatment planning evaluation. The evaluation must be completed within 30 calendar days of the patient's first request for services.
(5) A certified community behavioral health clinic shall provide outreach and education by:
(a) establishing an outreach team to work in partnership with hospitals and critical access hospitals to encourage individuals presenting with behavioral health needs at an emergency department to obtain ongoing behavioral health treatment through the clinic to reduce the need for emergency department care;
(b) working with local law enforcement agencies by:
(i) providing opportunities for training to, or attending training with, law enforcement officers in methods for responding to individuals with behavioral health needs; and
(ii) responding directly to individuals who have come into contact with law enforcement because of behavioral health issues; and
(c) designating staff members to encourage the use of the clinic's services by individuals who use a high volume of medicaid resources but who have not been actively receiving behavioral health treatment.
(6) The billing practices of a certified community behavioral health clinic must:
(a) provide that private insurance plans are billed first and that medicaid is billed as a payer of last resort;
(b) include a publicly available, income-based sliding fee scale; and
(c) establish that the certified community behavioral health clinic may not refuse services to a person who is unable to pay.
(7) In addition to any federally required reporting, each certified community behavioral health clinic shall collect and report to the department, in a deidentified manner, data on the following quality measures:
(a) changes in the functional assessment scores of patients; and
(b) baseline and subsequent changes in a patient's:
(i) status as housed or unhoused;
(ii) engagement in work; and
(iii) law enforcement involvement.
(8) A certified community behavioral health clinic that contracts with another provider for services as allowed under federal law and regulations and this section is responsible for:
(a) collecting and reporting on the data required under subsection (7) and any other information required by the department; and
(b) ensuring that the contracted provider follows all applicable state and federal laws and regulations.

Legislative History

En. Sec. 2, Ch. 495, L. 2025.