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LEGISLATURE
OF
THE
STATE
OF
IDAHO
Sixty-eighth
Legislature
Second
Regular
Session
-
2026
IN
THE
HOUSE
OF
REPRESENTATIVES
HOUSE
BILL
NO.
753
BY
HEALTH
AND
WELFARE
COMMITTEE
AN
ACT
1
RELATING
TO
ASSERTIVE
COMMUNITY
TREATMENT;
PROVIDING
LEGISLATIVE
INTENT;
2
AMENDING
CHAPTER
22,
TITLE
56,
IDAHO
CODE,
BY
THE
ADDITION
OF
A
NEW
3
SECTION
56
-
2208,
IDAHO
CODE,
TO
PROVIDE
LEGISLATIVE
APPROVAL
FOR
STATE
4
PLAN
AMENDMENTS
REGARDING
ASSERTIVE
COMMUNITY
TREATMENT;
AMENDING
TI
-
5
TLE
56,
IDAHO
CODE,
BY
THE
ADDITION
OF
A
NEW
CHAPTER
25,
TITLE
56,
IDAHO
6
CODE,
TO
DEFINE
TERMS,
TO
ESTABLISH
PROVISIONS
REGARDING
OBJECTIVES
7
AND
ELIGIBILITY
FOR
ASSERTIVE
COMMUNITY
TREATMENT,
TO
PROVIDE
FOR
THE
8
ESTABLISHMENT
OF
ASSERTIVE
COMMUNITY
TREATMENT
PROGRAMS
AND
TEAMS,
TO
9
ESTABLISH
PROVISIONS
REGARDING
MEASURES
AND
OUTCOMES,
TO
ESTABLISH
10
PROVISIONS
REGARDING
FIDELITY
STANDARDS
AND
PAYMENT
FOR
SERVICES,
AND
1
1
TO
PROVIDE
RULEMAKING
AUTHORITY;
AND
DECLARING
AN
EMERGENCY.
12
Be
It
Enacted
by
the
Legislature
of
the
State
of
Idaho:
13
SECTION
1.
LEGISLATIVE
INTENT.
It
is
the
intent
of
the
Legislature
that
14
assertive
community
treatment
services
be
generally
targeted
to
individuals
15
with
serious
and
persistent
mental
illness
who
experience
significant
func
-
16
tional
impairment
and
who
have
not
been
adequately
served
by
less
intensive
17
clinic
-
based
or
episodic
services.
18
SECTION
2.
That
Chapter
22,
Title
56,
Idaho
Code,
be,
and
the
same
is
19
hereby
amended
by
the
addition
thereto
of
a
NEW
SECTION
,
to
be
known
and
des
-
20
ignated
as
Section
56
-
2208,
Idaho
Code,
and
to
read
as
follows:
21
56
-
2208.
LEGISLATIVE
APPROVAL
-
-
ASSERTIVE
COMMUNITY
TREATMENT.
The
22
department
of
health
and
welfare
is
authorized
to
seek
and
shall
submit
a
23
state
plan
amendment
to
the
centers
for
medicare
and
medicaid
services
no
24
later
than
March
1,
2026,
to
provide
assertive
community
treatment
as
a
re
-
25
habilitative
service
in
accordance
with
the
provisions
of
chapter
25,
title
26
56,
Idaho
Code.
27
SECTION
3.
That
Title
56,
Idaho
Code,
be,
and
the
same
is
hereby
amended
28
by
the
addition
thereto
of
a
NEW
CHAPTER
,
to
be
known
and
designated
as
Chap
-
29
ter
25,
Title
56,
Idaho
Code,
and
to
read
as
follows:
30
CHAPTER
25
31
ASSERTIVE
COMMUNITY
TREATMENT
32
56
-
2501.
DEFINITIONS.
As
used
in
this
chapter:
33
(1)
"Assertive
community
treatment"
or
"ACT"
means
a
multidisci
-
34
plinary,
community
-
based
behavioral
health
service
model
that
provides
35
intensive,
comprehensive,
and
individualized
treatment
and
support
ser
-
36
vices
to
eligible
participants
with
serious
and
persistent
mental
illness.
37
An
ACT
team
shall:
38
2
(a)
Be
available
to
provide
services
twenty
-
four
(24)
hours
per
day,
1
seven
(7)
days
per
week;
2
(b)
Deliver
services
primarily
in
community
-
based
settings
as
clini
-
3
cally
appropriate;
4
(c)
Provide
a
full
range
of
treatment,
rehabilitation,
and
support
ser
-
5
vices
through
a
team
based
approach;
6
(d)
Address
complex
behavioral
health
needs
through
integrated
psychi
-
7
atric,
medical,
substance
use,
rehabilitative,
and
peer
support
ser
-
8
vices;
9
(e)
Operate
in
accordance
with
applicable
state
requirements
and
the
10
adopted
fidelity
model;
and
1
1
(f)
Include
an
interdisciplinary
team
composed
of,
at
a
minimum,
or
as
12
otherwise
determined
by
the
adopted
fidelity
model:
13
(i)
Licensed
nursing
staff;
14
(ii)
Licensed
practitioners
practicing
within
the
scope
of
their
15
licensure;
16
(iii)
Master's
or
doctoral
level
mental
health
professionals;
17
(iv)
Clinical
supervision
provided
by
a
master's
or
doctoral
18
level
mental
health
professional
within
the
scope
of
their
licen
-
19
sure;
20
(v)
Paraprofessional
staff
qualified
to
provide
skills
-
build
-
21
ing,
psychosocial
rehabilitation,
and
case
management
services;
22
(vi)
Certified
peer
support
specialists;
23
(vii)
Staff
trained
and
qualified
to
provide
assessment
and
24
treatment
for
substance
use
disorders;
and
25
(viii)
Administrative
support
staff.
26
(2)
"Department"
means
the
Idaho
department
of
health
and
welfare.
27
56
-
2502.
ASSERTIVE
COMMUNITY
TREATMENT
-
-
OBJECTIVES
-
-
ELIGIBIL
-
28
ITY.
(1)
Assertive
community
treatment
is
intensive
nonresidential
treat
-
29
ment
and
rehabilitative
mental
health
services
provided
to
eligible
par
-
30
ticipants
with
serious
and
persistent
mental
illness.
Assertive
community
31
treatment
is
delivered
through
a
single,
fixed
entity
per
region
responsible
32
for
treatment,
rehabilitation,
and
support
needs
for
participants.
Ser
-
33
vices
are
offered
twenty
-
four
(24)
hours
per
day,
seven
(7)
days
per
week,
34
in
community
-
based
settings
or
other
settings
as
clinically
appropriate
and
35
consistent
with
the
state's
chosen
assertive
community
treatment
fidelity
36
model.
The
objectives
of
assertive
community
treatment
include:
37
(a)
Preventing
or
reducing
symptoms
or
behaviors
that
may
result
in
the
38
need
for
recurrent
use
of
inpatient
services
or
high
-
cost
intervention
39
systems,
including
law
enforcement
or
emergency
medical
systems
inter
-
40
actions,
or
incarceration;
and
41
(b)
Increasing
the
skills
and
behaviors
that
enhance
the
participant's
42
ability
to
remain
in
the
community.
43
(2)
To
ensure
efficient
use
of
public
resources
and
appropriate
target
-
44
ing
of
services,
a
participant
is
eligible
for
assertive
community
treatment
45
services
only
if
the
participant
meets
the
eligibility
criteria
listed
in
46
the
state's
chosen
assertive
community
treatment
fidelity
model
and:
47
3
(a)
Has
a
pattern
of
frequent
use
of
crisis
services,
repeated
hospi
-
1
talizations,
incarceration,
or
other
high
-
cost
services
related
to
the
2
diagnosed
disorder;
3
(b)
Has
a
primary
diagnosis
of
serious
and
persistent
mental
illness,
4
as
defined
in
section
39
-
3122,
Idaho
Code,
consistent
with
the
most
5
recent
diagnostic
and
statistical
manual
of
mental
disorders,
and
6
demonstrates
significant
functional
impairment
that
substantially
in
-
7
terferes
with
the
individual's
ability
to
function
independently
in
one
8
(1)
or
more
major
life
activities;
and
9
(c)
Has
symptoms
and
behaviors
as
evidenced
by
one
(1)
or
more
of
the
10
following:
1
1
(i)
A
history
of
alcohol
and
drug
abuse
in
combination
with
psy
-
12
chiatric
symptoms
or
other
serious
medical
or
physical
problems;
13
(ii)
A
pattern
of
isolation
with
extremely
poor
or
nonexistent
so
-
14
cial
or
family
support;
15
(iii)
A
pattern
of
inability
to
provide
for
basic
needs
for
food,
16
clothing,
and
shelter;
17
(iv)
A
pattern
of
urgent
and
severe
psychiatric
and
other
concomi
-
18
tant
medical
difficulties;
or
19
(v)
Has
failed
to
remain
engaged
in
or
respond
to
conventional
20
services,
such
as
case
management,
medication,
outpatient
treat
-
21
ment,
or
day
programs.
22
(3)
Additional
requirements
in
selecting
participants
for
assertive
23
community
treatment
shall
include
at
least
one
(1)
of
the
following:
24
(a)
A
written
opinion
by
a
licensed
mental
health
professional
that
the
25
participant
needs
mental
health
services
that
cannot
be
met
with
other
26
available
community
-
based
services
or
is
likely
to
experience
a
mental
27
health
crisis
or
require
a
more
restrictive
setting
if
assertive
commu
-
28
nity
treatment
is
not
provided;
or
29
(b)
Whether
or
not
other
community
-
based
services
that
are
appropriate
30
to
the
participant's
needs
and
reasonably
available
would
be
equally
or
31
more
effective
in
treating
the
participant,
as
evidenced
by
consistent
32
and
extensive
efforts
to
treat
the
participant.
33
(4)
Assertive
community
treatment
services
shall
be
provided
as
a
re
-
34
habilitative
service
under
the
state
medicaid
plan,
consistent
with
federal
35
medicaid
law
and
implementing
regulations.
The
purpose
of
the
service
is
to
36
restore,
maintain,
and
improve
functional
capacity,
reduce
reliance
on
in
-
37
stitutional
care,
and
support
individuals
in
living
successfully
in
inte
-
38
grated
community
settings.
39
(5)(a)
Assertive
community
treatment
services
shall
be
available
to
40
eligible
individuals
who
meet
medical
necessity
and
program
eligibil
-
41
ity
criteria
established
consistent
with
the
state
medicaid
plan
and
42
applicable
federal
requirements.
43
(b)
The
department
of
health
and
welfare
or
its
designee
shall
adminis
-
44
ter
assertive
community
treatment
services
in
a
manner
consistent
with
45
the
adopted
fidelity
model,
including
required
staffing
ratios
and
team
46
composition,
to
ensure
program
integrity
and
effectiveness.
47
(c)
The
number
of
participants
served
by
assertive
community
treatment
48
teams
shall
be
determined
based
on
demonstrated
clinical
need,
provider
49
4
capacity,
and
compliance
with
fidelity
standards
and
shall
not
be
sub
-
1
ject
to
statutory
enrollment
caps.
2
56
-
2503.
ASSERTIVE
COMMUNITY
TREATMENT
PROGRAM
-
-
TEAM.
(1)
The
de
-
3
partment
of
health
and
welfare
or
its
designee
shall
establish
an
assertive
4
community
treatment
program
consistent
with
a
standardized,
nationally
rec
-
5
ognized
assertive
community
treatment
framework
and
the
state's
adopted
fi
-
6
delity
model
and
shall
adopt
rules,
subject
to
legislative
approval,
regard
-
7
ing
staffing
and
service
provision
that
address:
8
(a)
Team
composition
and
staffing
patterns
based
on
the
anticipated
9
participant
population
and
in
accordance
with
the
requirements
of
this
10
section;
1
1
(b)
Training
and
supervision,
including
initial
and
ongoing
cross
-
dis
-
12
ability
training,
if
applicable;
13
(c)
Communication
among
team
members
regarding
participant
condition,
14
supported
by
the
assignment
of
daily
staff
responsibilities
and
regu
-
15
lar,
frequent
staffing;
16
(d)
Days
and
hours
of
operation;
17
(e)
An
after
-
hours
plan,
including
on
-
call
coverage
and
linkages
with
18
appropriate
emergency
services;
19
(f)
Participant
selection
procedures
and
criteria
consistent
with
the
20
provisions
of
section
56
-
2502,
Idaho
Code;
21
(g)
Description
of
service
provision
by
an
assertive
community
treat
-
22
ment
team
that
aligns
with
the
adopted
assertive
community
treatment
23
fidelity
model;
and
24
(h)
Policies
regarding
quality
assurance
and
quality
improvement,
in
-
25
cluding
outcome
measures.
26
(2)
The
assertive
community
treatment
team
shall
provide
service
27
twenty
-
four
(24)
hours
per
day,
seven
(7)
days
per
week,
and
be
prepared
to
28
carry
out
a
full
range
of
treatment
functions.
The
team
shall
be
interdis
-
29
ciplinary
and
structured
to
meet
the
complex
needs
of
participants
wherever
30
and
whenever
clinically
appropriate
and
shall
include
the
staffing
roles
re
-
31
quired
pursuant
to
section
56
-
2501,
Idaho
Code,
unless
otherwise
determined
32
by
the
fidelity
model.
33
(3)
Each
member
of
the
assertive
community
treatment
team
shall
meet
34
applicable
Idaho
licensure
and
qualification
requirements
and
shall
be
su
-
35
pervised
consistent
with
their
role
and
scope
of
practice.
36
(4)
The
participant
-
to
-
staff
ratio
shall
be
based
on
the
needs
of
the
37
participants
for
whom
the
team
is
assigned
responsibility.
The
participant
-
38
to
-
staff
ratio
shall
be
ten
(10)
participants
to
one
(1)
staff
person.
In
no
39
event
shall
the
ratio
exceed
twelve
(12)
participants
to
one
(1)
staff
per
-
40
son.
Staffing
levels
and
team
roles
shall
be
consistent
with
the
adopted
as
-
41
sertive
community
treatment
fidelity
model
chosen
by
the
state.
42
(5)
The
team
shall
provide
at
least
two
(2)
contacts
per
week
to
partic
-
43
ipants
experiencing
severe
symptoms
or
significant
problems
in
daily
liv
-
44
ing.
When
a
participant
is
unable
to
be
located
or
declines
contact,
the
team
45
shall
make
and
document
reasonable
outreach
efforts
consistent
with
the
par
-
46
ticipant's
individualized
treatment
plan.
Each
participant
shall
be
seen
47
face
-
to
-
face
by
an
employee
or
contractor
in
accordance
with
the
schedule
48
specified
in
the
participant's
individualized
treatment
plan.
49
5
(6)
Assertive
community
treatment
services
shall
be
delivered
as
a
dis
-
1
tinct,
integrated
service
model
by
a
single
interdisciplinary
team
that
as
-
2
sumes
primary
responsibility
for
the
assessment,
planning,
coordination,
3
and
delivery
of
all
assertive
community
treatment
services,
consistent
with
4
the
adopted
fidelity
model.
Assertive
community
treatment
services
shall
be
5
delivered
through
the
integrated
team
based
model
and
shall
not
be
provided
6
across
multiple
provider
entities
or
delivery
systems
in
a
manner
that
un
-
7
dermines
model
fidelity.
When
a
participant
requires
specialized
services
8
that
are
not
available
through
the
assigned
assertive
community
treatment
9
team,
such
services
may
be
obtained
through
other
licensed
or
medicaid
-
en
-
10
rolled
providers;
provided
that
the
delivery
of
individual
service
compo
-
1
1
nents
outside
the
integrated
assertive
community
treatment
model
does
not
12
constitute
assertive
community
treatment.
13
56
-
2504.
MEASURES
AND
OUTCOMES.
(1)
Assertive
community
treatment
ob
-
14
jectives
for
a
participant
shall
be
addressed
by
activities
designed
to:
15
(a)
Promote
symptom
stability
and
the
appropriate
use
of
medication;
16
(b)
Restore
personal,
community
living,
and
social
skills
necessary
17
for
independent
functioning;
18
(c)
Promote
and
maintain
physical
health;
19
(d)
Establish
access
to
public
benefits,
housing,
work,
and
social
op
-
20
portunities;
and
21
(e)
Promote
and
maintain
the
highest
practicable
level
of
functioning
22
in
the
community.
23
(2)
Assertive
community
treatment
services
shall
be
delivered
in
a
re
-
24
covery
-
oriented
manner
and
shall
focus
on
rehabilitative
outcomes,
includ
-
25
ing:
26
(a)
Improved
functional
capacity;
27
(b)
Increased
housing
stability;
28
(c)
Reduced
hospitalizations
and
justice
system
involvement;
29
(d)
Enhanced
community
integration;
and
30
(e)
Improved
quality
of
life.
31
(3)
Assertive
community
treatment
services
shall
be
delivered
primar
-
32
ily
in
community
settings
where
participants
live,
work,
or
receive
support
33
and
shall
not
be
dependent
on
clinic
-
based
or
office
-
based
service
deliv
-
34
ery.
Services
shall
be
provided
through
mobile,
in
-
person
outreach
and
35
engagement
that
meets
participants
where
they
are,
in
accordance
with
the
36
standards
set
forth
in
this
section,
to
promote
engagement,
participation
in
37
services,
and
participation
in
community
life.
38
(4)
If
a
participant's
needs
can
be
adequately
and
appropriately
ad
-
39
dressed
with
an
average
of
fewer
than
seven
(7)
face
-
to
-
face
contacts
per
40
month
during
any
three
(3)
consecutive
month
period,
the
participant's
indi
-
41
vidualized
treatment
plan
shall
be
reviewed
to
determine
whether
less
inten
-
42
sive
service
alternatives
may
be
appropriate
in
lieu
of
assertive
community
43
treatment
services.
If
it
is
determined
that
less
intensive
services
can
44
meet
the
participant's
needs
over
the
long
term,
the
clinical
basis
for
that
45
determination
shall
be
documented,
a
plan
for
continuity
of
care
shall
be
46
established,
and
the
participant
shall
no
longer
be
eligible
for
assertive
47
community
treatment
services.
48
6
(5)
Providers
shall
report
standardized
outcome
measures
as
specified
1
by
the
adopted
assertive
community
treatment
fidelity
model,
as
determined
2
by
the
department
or
its
designee,
which
may
include
reductions
in
psychi
-
3
atric
hospitalizations,
reductions
in
days
of
incarceration,
improvements
4
in
participant
housing
stability,
and
increased
engagement
with
family
and
5
community
supports.
6
(6)
A
participant
shall
not
be
discharged
from
assertive
community
7
treatment
services
solely
for
failure
to
comply
with
a
treatment
plan
or
8
other
expectations,
except
as
otherwise
provided
in
this
section.
A
partic
-
9
ipant
may
be
discharged
only
upon
meeting
at
least
one
(1)
of
the
following
10
criteria:
1
1
(a)
A
change
in
the
participant's
residence
to
a
location
out
of
the
12
service
area;
13
(b)
Incarceration
or
long
-
term
hospitalization
of
the
participant
for
14
a
period
exceeding
thirty
(30)
days.
In
such
cases,
the
provider
shall
15
prioritize
the
participant
for
re
-
enrollment
in
assertive
community
16
treatment
services
upon
the
participant's
anticipated
return
to
the
17
community
if
the
participant
requests
services
and
the
level
of
care
18
remains
appropriate;
19
(c)
The
participant
elects
to
withdraw
from
services,
and
documented
20
attempts
by
the
program
to
re
-
engage
the
participant
have
not
been
suc
-
21
cessful;
22
(d)
The
participant
and
the
team
determine
that
assertive
community
23
treatment
services
are
no
longer
necessary
based
on
the
attainment
of
24
the
individual
treatment
plan
goals
and
that
a
less
intensive
level
of
25
care
would
adequately
address
the
participant's
current
needs;
or
26
(e)
The
participant
has
engaged
in
documented
threats,
acts
of
vio
-
27
lence,
or
abusive
conduct
toward
members
of
the
assertive
community
28
treatment
team
or
its
contractors
that
jeopardize
staff
safety.
29
56
-
2505.
FIDELITY
STANDARDS
AND
PAYMENT
FOR
SERVICES.
(1)
To
ensure
30
accountability
for
state
funding
and
measurable
program
performance,
as
-
31
sertive
community
treatment
provider
teams
shall
achieve
an
initial
minimum
32
score
of
3.0
on
the
tool
for
measurement
of
assertive
community
treatment
33
or
another
nationally
recognized
assertive
community
treatment
fidelity
34
instrument
approved
by
the
department
or
its
designee.
Provider
teams
shall
35
achieve
a
minimum
score
of
4.0
within
three
(3)
years
of
initial
certifi
-
36
cation.
The
department
or
its
designee
may
grant
time
-
limited
variances
37
from
fidelity
thresholds
for
newly
established
teams
or
teams
operating
in
38
regions
with
documented
workforce
shortages,
provided
that
a
corrective
ac
-
39
tion
plan
is
implemented
and
progress
toward
full
fidelity
is
demonstrated.
40
Any
variance
granted
under
this
subsection
shall
not
exceed
six
(6)
months,
41
unless
extended
by
the
department
or
its
designee
upon
a
showing
of
substan
-
42
tial
progress
toward
the
corrective
action
plan.
Variances
shall
not
be
43
renewed
without
demonstrated
compliance
with
fidelity
requirements.
44
(2)
Assertive
community
treatment
services
reimbursed
under
the
state
45
medicaid
plan
shall
be
reimbursed
using
a
single
monthly
assertive
com
-
46
munity
treatment
service
unit
per
enrolled
participant,
inclusive
of
all
47
rehabilitative
services,
outreach,
coordination,
travel
time,
and
crisis
48
response
furnished
during
the
applicable
billing
month,
with
all
covered
49
7
services
aggregated
into
a
single
unit
of
reimbursement.
The
aggregated
1
amount
may
be
billed
on
service
or
non
-
service
days
for
up
to
thirty
(30)
days
2
following
the
last
successful
contact,
provided
that
continued
outreach
3
efforts
are
documented
and
consistent
with
the
state's
adopted
assertive
4
community
treatment
fidelity
model.
Services
and
interventions
reimbursed
5
pursuant
to
this
subsection
shall
be
consistent
with
the
participant's
in
-
6
dividualized
treatment
plan
and
may
include
direct
services,
collateral
7
contacts,
crisis
response,
or
assertive
outreach.
Rates
shall
be
reviewed
8
and
adjusted
annually
using
the
centers
for
medicare
and
medicaid
services
9
medicare
economic
index
to
maintain
provider
network
stability
and
fiscal
10
predictability.
One
(1)
assertive
community
treatment
provider
shall
be
1
1
selected
per
region
to
provide
assertive
community
treatment
services.
12
(3)
For
services
reimbursed
under
the
state
medicaid
plan,
all
services
13
furnished
as
part
of
assertive
community
treatment
shall
be
reimbursed
only
14
through
the
assertive
community
treatment
aggregated
rate
and
shall
not
be
15
separately
billed
or
reimbursed
under
any
other
medicaid
benefit
or
service
16
category.
Nothing
in
this
subsection
shall
be
construed
to
prohibit
the
use
17
of
other
state
or
non
-
medicaid
funding
sources
to
support
assertive
commu
-
18
nity
treatment
services
for
individuals
not
eligible
for
medicaid,
provided
19
that
duplicate
payment
for
the
same
service
does
not
occur.
20
56
-
2506.
RULEMAKING
AUTHORITY.
The
department
of
health
and
welfare
21
shall
promulgate
rules,
subject
to
legislative
approval,
pursuant
to
chap
-
22
ter
52,
title
67,
Idaho
Code,
as
necessary
to
implement
the
provisions
of
23
this
chapter,
including
provider
certification
standards,
reimbursement
24
rates,
reporting
requirements,
and
compliance
monitoring,
consistent
with
25
federal
medicaid
requirements
and
the
adopted
assertive
community
treatment
26
fidelity
model.
27
SECTION
4.
An
emergency
existing
therefor,
which
emergency
is
hereby
28
declared
to
exist,
this
act
shall
be
in
full
force
and
effect
on
and
after
its
29
passage
and
approval.
30