Adds to existing law to provide legislative approval for and to establish provisions regarding assertive community treatment.

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 ACT1 RELATING TO ASSERTIVE COMMUNITY TREATMENT; PROVIDING LEGISLATIVE INTENT;2 AMENDING CHAPTER 22, TITLE 56, IDAHO CODE, BY THE ADDITION OF A NEW3 SECTION 56-2208, IDAHO CODE, TO PROVIDE LEGISLATIVE APPROVAL FOR STATE4 PLAN AMENDMENTS REGARDING ASSERTIVE COMMUNITY TREATMENT; AMENDING TI-5 TLE 56, IDAHO CODE, BY THE ADDITION OF A NEW CHAPTER 25, TITLE 56, IDAHO6 CODE, TO DEFINE TERMS, TO ESTABLISH PROVISIONS REGARDING OBJECTIVES7 AND ELIGIBILITY FOR ASSERTIVE COMMUNITY TREATMENT, TO PROVIDE FOR THE8 ESTABLISHMENT OF ASSERTIVE COMMUNITY TREATMENT PROGRAMS AND TEAMS, TO9 ESTABLISH PROVISIONS REGARDING MEASURES AND OUTCOMES, TO ESTABLISH10 PROVISIONS REGARDING FIDELITY STANDARDS AND PAYMENT FOR SERVICES, AND11 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 that14 assertive community treatment services be generally targeted to individuals15 with serious and persistent mental illness who experience significant func-16 tional impairment and who have not been adequately served by less intensive17 clinic-based or episodic services.18

SECTION 2. That Chapter 22, Title 56, Idaho Code, be, and the same is19 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. The22 department of health and welfare is authorized to seek and shall submit a23 state plan amendment to the centers for medicare and medicaid services no24 later than March 1, 2026, to provide assertive community treatment as a re-25 habilitative service in accordance with the provisions of chapter 25, title26 56, Idaho Code.27

SECTION 3. That Title 56, Idaho Code, be, and the same is hereby amended28 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 2531 ASSERTIVE COMMUNITY TREATMENT32 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 provides35 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 the10 adopted fidelity model; and11 (f) Include an interdisciplinary team composed of, at a minimum, or as12 otherwise determined by the adopted fidelity model:13 (i) Licensed nursing staff;14 (ii) Licensed practitioners practicing within the scope of their15 licensure;16 (iii) Master's or doctoral level mental health professionals;17 (iv) Clinical supervision provided by a master's or doctoral18 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 and24 treatment for substance use disorders; and25 (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 community31 treatment is delivered through a single, fixed entity per region responsible32 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 and35 consistent with the state's chosen assertive community treatment fidelity36 model. The objectives of assertive community treatment include:37 (a) Preventing or reducing symptoms or behaviors that may result in the38 need for recurrent use of inpatient services or high-cost intervention39 systems, including law enforcement or emergency medical systems inter-40 actions, or incarceration; and41 (b) Increasing the skills and behaviors that enhance the participant's42 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 treatment45 services only if the participant meets the eligibility criteria listed in46 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 the2 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 most5 recent diagnostic and statistical manual of mental disorders, and6 demonstrates significant functional impairment that substantially in-7 terferes with the individual's ability to function independently in one8 (1) or more major life activities; and9 (c) Has symptoms and behaviors as evidenced by one (1) or more of the10 following:11 (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; or19 (v) Has failed to remain engaged in or respond to conventional20 services, such as case management, medication, outpatient treat-21 ment, or day programs.22 (3) Additional requirements in selecting participants for assertive23 community treatment shall include at least one (1) of the following:24 (a) A written opinion by a licensed mental health professional that the25 participant needs mental health services that cannot be met with other26 available community-based services or is likely to experience a mental27 health crisis or require a more restrictive setting if assertive commu-28 nity treatment is not provided; or29 (b) Whether or not other community-based services that are appropriate30 to the participant's needs and reasonably available would be equally or31 more effective in treating the participant, as evidenced by consistent32 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 federal35 medicaid law and implementing regulations. The purpose of the service is to36 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 to40 eligible individuals who meet medical necessity and program eligibil-41 ity criteria established consistent with the state medicaid plan and42 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 with45 the adopted fidelity model, including required staffing ratios and team46 composition, to ensure program integrity and effectiveness.47 (c) The number of participants served by assertive community treatment48 teams shall be determined based on demonstrated clinical need, provider49

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 assertive4 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 anticipated9 participant population and in accordance with the requirements of this10 section;11 (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 with18 appropriate emergency services;19 (f) Participant selection procedures and criteria consistent with the20 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 treatment23 fidelity model; and24 (h) Policies regarding quality assurance and quality improvement, in-25 cluding outcome measures.26 (2) The assertive community treatment team shall provide service27 twenty-four (24) hours per day, seven (7) days per week, and be prepared to28 carry out a full range of treatment functions. The team shall be interdis-29 ciplinary and structured to meet the complex needs of participants wherever30 and whenever clinically appropriate and shall include the staffing roles re-31 quired pursuant to section 56-2501, Idaho Code, unless otherwise determined32 by the fidelity model.33 (3) Each member of the assertive community treatment team shall meet34 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 the37 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 no39 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 team45 shall make and document reasonable outreach efforts consistent with the par-46 ticipant's individualized treatment plan. Each participant shall be seen47 face-to-face by an employee or contractor in accordance with the schedule48 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 with4 the adopted fidelity model. Assertive community treatment services shall be5 delivered through the integrated team based model and shall not be provided6 across multiple provider entities or delivery systems in a manner that un-7 dermines model fidelity. When a participant requires specialized services8 that are not available through the assigned assertive community treatment9 team, such services may be obtained through other licensed or medicaid-en-10 rolled providers; provided that the delivery of individual service compo-11 nents outside the integrated assertive community treatment model does not12 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 necessary17 for independent functioning;18 (c) Promote and maintain physical health;19 (d) Establish access to public benefits, housing, work, and social op-20 portunities; and21 (e) Promote and maintain the highest practicable level of functioning22 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; and30 (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 support33 and shall not be dependent on clinic-based or office-based service deliv-34 ery. Services shall be provided through mobile, in-person outreach and35 engagement that meets participants where they are, in accordance with the36 standards set forth in this section, to promote engagement, participation in37 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 per40 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 community43 treatment services. If it is determined that less intensive services can44 meet the participant's needs over the long term, the clinical basis for that45 determination shall be documented, a plan for continuity of care shall be46 established, and the participant shall no longer be eligible for assertive47 community treatment services.48

6 (5) Providers shall report standardized outcome measures as specified1 by the adopted assertive community treatment fidelity model, as determined2 by the department or its designee, which may include reductions in psychi-3 atric hospitalizations, reductions in days of incarceration, improvements4 in participant housing stability, and increased engagement with family and5 community supports.6 (6) A participant shall not be discharged from assertive community7 treatment services solely for failure to comply with a treatment plan or8 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 following10 criteria:11 (a) A change in the participant's residence to a location out of the12 service area;13 (b) Incarceration or long-term hospitalization of the participant for14 a period exceeding thirty (30) days. In such cases, the provider shall15 prioritize the participant for re-enrollment in assertive community16 treatment services upon the participant's anticipated return to the17 community if the participant requests services and the level of care18 remains appropriate;19 (c) The participant elects to withdraw from services, and documented20 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 community23 treatment services are no longer necessary based on the attainment of24 the individual treatment plan goals and that a less intensive level of25 care would adequately address the participant's current needs; or26 (e) The participant has engaged in documented threats, acts of vio-27 lence, or abusive conduct toward members of the assertive community28 treatment team or its contractors that jeopardize staff safety.29 56-2505. FIDELITY STANDARDS AND PAYMENT FOR SERVICES. (1) To ensure30 accountability for state funding and measurable program performance, as-31 sertive community treatment provider teams shall achieve an initial minimum32 score of 3.0 on the tool for measurement of assertive community treatment33 or another nationally recognized assertive community treatment fidelity34 instrument approved by the department or its designee. Provider teams shall35 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 variances37 from fidelity thresholds for newly established teams or teams operating in38 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 be43 renewed without demonstrated compliance with fidelity requirements.44 (2) Assertive community treatment services reimbursed under the state45 medicaid plan shall be reimbursed using a single monthly assertive com-46 munity treatment service unit per enrolled participant, inclusive of all47 rehabilitative services, outreach, coordination, travel time, and crisis48 response furnished during the applicable billing month, with all covered49

7 services aggregated into a single unit of reimbursement. The aggregated1 amount may be billed on service or non-service days for up to thirty (30) days2 following the last successful contact, provided that continued outreach3 efforts are documented and consistent with the state's adopted assertive4 community treatment fidelity model. Services and interventions reimbursed5 pursuant to this subsection shall be consistent with the participant's in-6 dividualized treatment plan and may include direct services, collateral7 contacts, crisis response, or assertive outreach. Rates shall be reviewed8 and adjusted annually using the centers for medicare and medicaid services9 medicare economic index to maintain provider network stability and fiscal10 predictability. One (1) assertive community treatment provider shall be11 selected per region to provide assertive community treatment services.12 (3) For services reimbursed under the state medicaid plan, all services13 furnished as part of assertive community treatment shall be reimbursed only14 through the assertive community treatment aggregated rate and shall not be15 separately billed or reimbursed under any other medicaid benefit or service16 category. Nothing in this subsection shall be construed to prohibit the use17 of other state or non-medicaid funding sources to support assertive commu-18 nity treatment services for individuals not eligible for medicaid, provided19 that duplicate payment for the same service does not occur.20 56-2506. RULEMAKING AUTHORITY. The department of health and welfare21 shall promulgate rules, subject to legislative approval, pursuant to chap-22 ter 52, title 67, Idaho Code, as necessary to implement the provisions of23 this chapter, including provider certification standards, reimbursement24 rates, reporting requirements, and compliance monitoring, consistent with25 federal medicaid requirements and the adopted assertive community treatment26 fidelity model.27

SECTION 4. An emergency existing therefor, which emergency is hereby28 declared to exist, this act shall be in full force and effect on and after its29 passage and approval.30