(1) The behavioral health administration shall establish designated service areas to provide substance use disorder treatment and recovery services in a particular geographical region of the state. (2) To be selected as a designated managed service organization to provide services in a particular designated service area, a private corporation, for profit or not for profit, or a public agency, organization, or institution shall apply to the behavioral health administration for a designation in the form and manner specified by the commissioner or the commissioner's designee. The designation process is in lieu of a competitive bid process pursuant to the "Procurement Code", articles 101 to 112 of title 24. The commissioner or the commissioner's designee shall make the designation based on factors established by the commissioner or the commissioner's designee. The factors for designation established by the executive director or the executive director's designee include the following: (a) Whether the managed service organization has experience working with public treatment agencies and collaborating with other public agencies; (b) Whether the managed service organization has experience working with publicly funded clients, including expertise in treating priority populations designated by the behavioral health administration; (c) Whether the managed service organization has offices in and provides services in the substate planning area or is willing to relocate to the substate planning area; (d) Whether the managed service organization has experience using the cost-share principles used by the behavioral health administration in its contracts with providers and is willing to cost-share; (e) Whether the managed service organization has developed an effective, integrated information and fiscal reporting system and has experience working with and is able to comply with state and federal reporting requirements; (f) Whether the managed service organization has experience engaging in a clinical quality improvement process; and (g) Whether the managed service organization has experience with public funding requirements and state contracting requirements. (2.5) (a) On or before January 1, 2023, in order to promote transparency and accountability, the behavioral health administration shall require each managed service organization that has twenty-five percent or more ownership by providers of behavioral health services to comply with the following conflict of interest policies: (I) Providers who have ownership or board membership in a managed service organization shall not have control, influence, or decision-making authority in how funding is distributed to any provider or the establishment of provider networks. (II) The behavioral health administration shall quarterly review a managed service organization's funding allocation to ensure that all providers are being equally considered for funding. The behavioral health administration is authorized to review any other pertinent information to ensure the managed service organization is meeting state and federal rules and regulations and is not inappropriately giving preference to providers with ownership or board membership. (III) An employee of a contracted provider of a managed service organization shall not also be an employee of the managed service organization unless the employee is a medical director for the managed service organization. If the medical director is also an employee of a provider that has board membership or ownership in the managed service organization, the managed service organization shall develop policies, approved by the commissioner of the behavioral health administration, to mitigate any conflict of interest the medical director may have. (IV) A managed service organization's board shall not have more than fifty percent of contracted providers as board members, and the managed service organization is encouraged to have a community member on the managed service organization's board. (b) If the office is unable to contract with a managed service organization that meets the requirements of this subsection (2.5), the office may designate another existing managed service organization to temporarily provide the services for that region, for up to one year, pending designation of a new managed service organization. If the office is unable to designate a new managed service organization, the temporary managed service organization may continue to provide the regional substance use disorder services on a year by year basis. (c) As used in this subsection (2.5), unless the context otherwise requires: (I) "Medical director" means a physician who oversees the medical care and other designated care and services in a managed service organization. The medical director may be responsible for helping to develop clinical quality management and utilization management. (II) "Ownership" means an individual who is a legal proprietor of an organization, including a provider or individual who owns assets of an organization, or has a financial stake, interest, or governance role in the managed service organization. (3) The designation of a managed service organization by the commissioner, as described in subsection (2) of this section, is an initial decision of the department that may be reviewed by the executive director in accordance with the provisions of section 24-4-105. Review by the executive director in accordance with section 24-4-105 constitutes final agency action for purposes of judicial review. (4) (a) The terms and conditions for providing substance use disorder treatment and recovery services must be specified in the contract entered into between the behavioral health administration and the designated managed service organization. Contracts entered into between the behavioral health administration and the designated managed service organization must include terms and conditions prohibiting a designated managed service organization contracted treatment provider from denying or prohibiting access to medication-assisted treatment, as defined in section 23-21-803, for a substance use disorder. (b) Contracts entered into between the behavioral health administration and the designated managed service organization must include terms and conditions that outline the expectations for the designated managed service organization to invest in the state's recovery services infrastructure, which include peer-run recovery support services and specialized services for underserved populations. Investments are based on available appropriations. (5) The contract may include a provisional designation for ninety days. At the conclusion of the ninety-day provisional period, the commissioner may choose to revoke the contract or, subject to meeting the terms and conditions specified in the contract, may choose to extend the contract for a stated time period. (6) A managed service organization that is designated to serve a designated service area may subcontract with a network of service providers to provide treatment and recovery services for alcohol and drug abuse and substance use disorders within the particular designated service area. (7) (a) The commissioner may revoke the designation of a designated managed service organization upon finding that the managed service organization is in violation of the performance of the provisions of or rules promulgated pursuant to this article 80. The revocation must conform to the provisions and procedures specified in article 4 of title 24, and occur only after notice and an opportunity for a hearing is provided as specified in article 4 of title 24. A hearing to revoke a designation as a designated managed service organization constitutes final agency action for purposes of judicial review. (b) Once a designation has been revoked pursuant to subsection (7)(a) of this section, the commissioner may designate one or more service providers to provide the treatment services pending designation of a new designated managed service organization or may enter into contracts with subcontractors to provide the treatment services. (c) From time to time, the commissioner may solicit applications from applicants for managed service organization designation to provide substance use disorder treatment and recovery services for a specified planning area or areas.
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