Bill Analyses and Ratings
Bill Information: H0753 – Assertive Community Treatment Program Creation
Bill Summary
This bill creates a new Assertive Community Treatment (ACT) program in Idaho Code to provide intensive, 24/7 community-based mental health services for individuals with serious and persistent mental illness. The legislation authorizes the Department of Health and Welfare to submit a Medicaid state plan amendment to fund ACT as a rehabilitative service, establishing comprehensive requirements for program structure, team composition, and service delivery.
The bill defines strict eligibility criteria targeting individuals with patterns of frequent hospitalizations, crisis service use, or incarceration related to mental illness. It mandates interdisciplinary teams including licensed nurses, mental health professionals, peer support specialists, and substance use treatment staff, with participant-to-staff ratios capped at 12:1. Services must be delivered primarily in community settings where participants live and work, with teams available around the clock.
The legislation establishes a single monthly Medicaid reimbursement rate per enrolled participant that covers all rehabilitative services, outreach, coordination, and crisis response. It requires providers to meet nationally recognized fidelity standards, limits each region to one ACT provider, and grants the Department rulemaking authority to implement certification standards, reimbursement rates, and compliance monitoring.
Overall Assessment
This bill expands government-funded healthcare by creating a new Medicaid-reimbursed mental health program with detailed regulatory requirements for staffing, service delivery, and provider operations. The legislation limits each region to a single government-selected ACT provider, restricting market competition in mental health services. While targeting individuals with serious mental illness who frequently use crisis services and experience incarceration, the program increases state spending and regulatory oversight in the healthcare sector.
Rating Breakdown
ARTICLE I. RESPONSIBILITY IN GOVERNMENT (-1)
The bill creates an entirely new government program in Chapter 25, Title 56, establishing the ACT program with dedicated Medicaid funding. Section 56-2505(2) mandates monthly reimbursement for enrolled participants, and Section 56-2503(1) requires the department to establish the program with comprehensive regulatory oversight. This expands government size, spending, and administrative authority.
ARTICLE II. CITIZEN INVOLVEMENT IN GOVERNMENT (0)
The bill addresses mental health service delivery and does not relate to elections, voting procedures, citizen participation in government, or political processes.
ARTICLE III. EDUCATION (0)
The bill establishes mental health treatment services and does not address education policy, schools, curriculum, parental rights in education, or any education-related topics.
ARTICLE IV. AGRICULTURE (0)
The bill creates mental health treatment services and has no connection to agriculture, farming, ranching, or agricultural markets.
ARTICLE V. WATER (0)
The bill addresses mental health services and does not relate to water rights, water management, dams, or water policy.
ARTICLE VI. NATURAL RESOURCES AND ENVIRONMENT (0)
The bill creates mental health treatment programs and does not address natural resources, environmental policy, federal lands, or wilderness areas.
ARTICLE VII. ENERGY (0)
The bill establishes mental health services and has no connection to energy policy, energy independence, hydroelectric power, or nuclear energy.
ARTICLE VIII. IDAHO NATIONAL LABORATORIES (0)
The bill addresses mental health treatment and has no connection to the Idaho National Laboratory, nuclear research, or technology development.
ARTICLE IX. PRIVATE PROPERTY RIGHTS (0)
The bill creates mental health treatment services and does not address private property rights, eminent domain, property development, or takings.
ARTICLE X. STATE AND FEDERAL LANDS (0)
The bill establishes mental health services and has no connection to state or federal land management, land ownership, or land administration.
ARTICLE XI. WILDLIFE MANAGEMENT (0)
The bill addresses mental health treatment and has no connection to wildlife, fish and game management, hunting, fishing, or predator control.
ARTICLE XII. ECONOMY (-1)
Section 56-2505(2) explicitly states "One (1) assertive community treatment provider shall be selected per region," creating government-selected regional monopolies that restrict market entry and competition. The bill imposes extensive regulatory requirements on healthcare providers, including mandatory fidelity standards, staffing ratios, team composition requirements, and reporting obligations. This government intervention in the healthcare market contradicts principles of competitive, free-market enterprise.
ARTICLE XIII. HEALTH AND WELFARE (-1)
The bill creates a government-administered mental health program with extensive regulatory requirements including mandatory team composition (Section 56-2501(1)(f)), prescribed staffing ratios (Section 56-2503(4)), and detailed service delivery standards (Section 56-2504). Section 56-2505(1) imposes fidelity score requirements and government monitoring. This expands government regulation of healthcare delivery rather than supporting a private enterprise system with minimal government intervention.
ARTICLE XIV. AMERICAN FAMILY (0)
The bill addresses mental health treatment services for adults with serious mental illness and does not directly address family structure, marriage, parental rights, or family values.
ARTICLE XV. OLDER AMERICANS (0)
The bill creates mental health services for individuals with serious and persistent mental illness without specifically targeting or excluding older Americans. The eligibility criteria in Section 56-2502 are age-neutral.
ARTICLE XVI. LAW AND ORDER WITH JUSTICE (0)
While Section 56-2502(1)(a) mentions reducing incarceration as an objective, this is incidental to the bill's primary focus on mental health treatment. The bill operates in the healthcare domain and does not address criminal justice procedures, sentencing, law enforcement, or constitutional rights related to justice.
ARTICLE XVII. NATIONAL DEFENSE – SECURING THE BORDER (0)
The bill creates mental health treatment services and has no connection to national defense, military, veterans, border security, or terrorism.
ARTICLE XVIII. ELECTION OF JUDGES AND IDAHO SUPREME COURT JUSTICES (0)
The bill addresses mental health services and has no connection to judicial elections, judicial selection, or constitutional interpretation.
ARTICLE XIX. RELIGIOUS LIBERTY (0)
The bill creates mental health treatment services and does not address religious freedom, free exercise of religion, or the Religious Freedom Restoration Act.