Third Substitute H.B. 272

This document includes House Committee Amendments incorporated into the bill on Tue, Feb 21, 2012 at 11:52 AM by jeyring. -->

Representative Ronda Rudd Menlove proposes the following substitute bill:

1 PILOT PROGRAM FOR AUTISM SPECTRUM
2 DISORDERS SERVICES
3 2012 GENERAL SESSION
4 STATE OF UTAH
5 Chief Sponsor: Ronda Rudd Menlove
6 Senate Sponsor: ____________
7
8 LONG TITLE
9 General Description:
10 This bill creates a pilot program for autism spectrum disorders services in the Medicaid
11 program; for the private sector, non-Medicaid population through the Autism Treatment
12 Account; and for certain children of state employees administered by Public Employees'
13 Benefit and Insurance Program Act.
14 Highlighted Provisions:
15 This bill:
16 . provides a funding mechanism for the autism Medicaid waiver;
17 . directs the state Medicaid program to develop a Medicaid waiver to provide proven
18 effective services for children between the ages of two to six with autism spectrum
19 disorder;
20 . requires the department to convene a public process to develop the Medicaid
21 waiver;
22 . requires the department to include services for children located in rural and
23 underserved areas of the state;
24 . requires the department to measure the cost and the effectiveness of the treatments
25 and services for autism spectrum disorder;

26 . requires the department to report to the Legislative Health and Human Services
27 Interim Committee by November 30, 2013;
28 . amends provisions of the Autism Treatment Account to:
29 . update terminology used for autism treatment options;
30 . amend the uses of the account to focus on evaluation and treatment of children
31 between the ages of two to six years old with autism spectrum disorders;
32 . work with telehealth services to reach children in rural and underserved areas of
33 the state; and
34 . create a mechanism to identify children qualified for services, provide and pay
35 for services for children, and to evaluate effectiveness of treatments; and
36 . establishes a pilot program for autism services for certain children of state
37 employees administered by the Public Employees' Benefit and Insurance Program.
38 Money Appropriated in this Bill:
39 This bill appropriates in fiscal year 2011-12:
40 . to Department of Health - Medicaid Optional Services
41 . from General Fund, One-time $1,500,000 to fund autism treatment; and
42 . to Department of Human Services - Child and Family Services
43 . from General Fund, One-time ($1,500,000) to fund autism treatment.
44 This bill provides intent language making certain Fiscal Year 2012 appropriations in the
45 Department of Health nonlapsing for purposes of studying children with autism
46 spectrum disorder.
47 Other Special Clauses:
48 None
49 Utah Code Sections Affected:
50 AMENDS:
51 26-18-402, as last amended by Laws of Utah 2010, Chapter 340
52 26-52-102, as enacted by Laws of Utah 2010, Chapter 69
53 26-52-201, as enacted by Laws of Utah 2010, Chapter 69
54 26-52-202, as last amended by Laws of Utah 2011, Chapter 340
55 ENACTS:
56 26-18-407, Utah Code Annotated 1953

57 26-52-203, Utah Code Annotated 1953
58 49-20-411, Utah Code Annotated 1953
59
60 Be it enacted by the Legislature of the state of Utah:
61 Section 1. Section 26-18-402 is amended to read:
62 26-18-402. Medicaid Restricted Account.
63 (1) There is created a restricted account in the General Fund known as the Medicaid
64 Restricted Account.
65 (2) (a) Except as provided in Subsection (3), the following shall be deposited into the
66 Medicaid Restricted Account:
67 (i) any general funds appropriated to the department for the state plan for medical
68 assistance or for the Division of Health Care Financing that are not expended by the
69 department in the fiscal year for which the general funds were appropriated and which are not
70 otherwise designated as nonlapsing shall lapse into the Medicaid Restricted Account;
71 (ii) any unused state funds that are associated with the Medicaid program, as defined in
72 Section 26-18-2 , from the Department of Workforce Services and the Department of Human
73 Services; and
74 (iii) any penalties imposed and collected under:
75 (A) Section 17B-2a-818.5 ;
76 (B) Section 19-1-206 ;
77 (C) Section 79-2-404 ;
78 (D) Section 63A-5-205 ;
79 (E) Section 63C-9-403 ; or
80 (F) Section 72-6-107.5 .
81 (b) The account shall earn interest and all interest earned shall be deposited into the
82 account.
83 (c) The Legislature may appropriate money in the restricted account to fund programs
84 that expand medical assistance coverage and private health insurance plans to low income
85 persons who have not traditionally been served by Medicaid, including the Utah Children's
86 Health Insurance Program created in Chapter 40.
87 (3) For fiscal years 2008-09, 2009-10, [and] 2010-11, 2011-12, and 2012-13 the

88 following funds are nonlapsing:
89 (a) any general funds appropriated to the department for the state plan for medical
90 assistance, or for the Division of Health Care Financing that are not expended by the
91 department in the fiscal year in which the general funds were appropriated; and
92 (b) funds described in Subsection (2)(a)(ii).
93 Section 2. Section 26-18-407 is enacted to read:
94 26-18-407. Medicaid waiver for autism spectrum disorder.
95 (1) For purposes of this section "autism spectrum disorder" means a pervasive
96 developmental disorder as defined by the most recent edition of the Diagnostic and Statistical
97 Manual on Mental Disorders, including:
98 (a) Autistic disorder;
99 (b) Asperger's disorder; and
100 (c) pervasive developmental disorder not otherwise specified.
101 (2) The department shall, by July 1, 2012, apply for a Medicaid waiver with the
102 Centers for Medicare and Medicaid Services within the United States Department of Health
103 and Human Services to implement a autism spectrum disorder program within the state
104 Medicaid program.
105 (3) The autism spectrum disorders waiver program shall:
106 (a) provide services to children between the ages of two years and six years with
107 autism spectrum disorders;
108 (b) accept application for the program during periods of open enrollment;
109 (c) initially provide services for up to 500 children, as funding permits;
110 (d) convene a public process with the Department of Human Services to develop the
111 benefits and services to include in the autism waiver program, which services should include:
112 (i) demonstrated effective treatments;
113 (ii) methods to engage family members in the treatment process; and
114 (iii) outreach to children in rural and underserved areas of the state; and
115 (e) include a mechanism to evaluate the cost, effectiveness, and outcomes of the
116 different services provided as part of the autism waiver program.
117 (4) The department shall report to the Legislature's Health and Human Services Interim
118 Committee by November 30, 2013, and prior to each November 30 thereafter while the waiver

119 is in effect regarding:
120 (a) the number of children diagnosed with autism spectrum disorder and the number of
121 children served under the waiver;
122 (b) success involving families in supporting treatment plans for autistic children;
123 (c) the cost of the autism waiver program; and
124 (d) the outcomes and effectiveness of the services offered by the autism waiver
125 program.
126 Section 3. Section 26-52-102 is amended to read:
127 26-52-102. Definitions.
128 As used in this chapter:
129 (1) "Account" means the Autism Treatment Account created in Section 26-52-201 .
130 (2) "Applied behavior analysis" means the design, implementation, and evaluation of
131 environmental modifications, using behavioral stimuli and consequences, to produce socially
132 significant improvement in human behavior, including the use of direct observation,
133 measurement, and functional analysis of the relationship between environment and behavior
134 that are:
135 (a) necessary to develop, maintain, or restore, to the maximum extent practicable, the
136 functioning of an individual; and
137 (b) provided or supervised by a:
138 (i) board certified behavior analyst; or
139 (ii) a licensed psychologist with equivalent university training and supervised
140 experience who is working toward board certification in applied behavior analysis.
141 [(2)] (3) "Autism spectrum disorder" means a pervasive developmental disorder as
142 defined by the most recent edition of the Diagnostic and Statistical Manual on Mental
143 Disorders, including:
144 (a) Autistic disorder;
145 (b) Asperger's disorder; and
146 (c) pervasive developmental disorder not otherwise specified.
147 [(3)] (4) "Committee" means the Autism Treatment Account Advisory Committee
148 created under Section 26-52-202 .
149 [(4) "Early intensive behavior therapy" means therapy that:]

150 [(a) involves intensive behavioral intervention over an extended period of time;]
151 [(b) is evidence-based; and]
152 [(c) is generally accepted by the medical community or the American Academy of
153 Pediatrics as an effective treatment for young children with an autism spectrum disorder.]
154 Section 4. Section 26-52-201 is amended to read:
155 26-52-201. Autism Treatment Account.
156 (1) There is created within the General Fund a restricted account known as the Autism
157 Treatment Account.
158 (2) (a) The account shall consist of:
159 [(a)] (i) gifts, grants, devises, donations, and bequests of real property, personal
160 property, or services, from any source, or any other conveyance that may be made to the
161 account from private sources;
162 [(b)] (ii) interest and other earnings derived from the account money; and
163 [(c)] (iii) any additional amounts as appropriated by the Legislature.
164 (b) (i) For purposes of this subsection, the Affordable Care Act is as defined in Section
165 31A-2-212 .
166 (ii) If an insurer contributes to the Autism Treatment Account, for purposes of
167 calculating an insurer's medical loss ratio under the Affordable Care Act, the insurance
168 commissioner shall consider the contribution to the Autism Treatment Account as a claims
169 payment by the insurer.
170 (3) (a) Except as provided under Subsection (3)(b), the executive director of the
171 department shall be responsible for administering the account.
172 (b) The committee shall be responsible for the following actions in relation to the
173 account, consistent with the requirements of this title:
174 (i) prioritizing and allocating uses for account money, as permitted under Subsection
175 (4);
176 (ii) determining [what] which providers [or organizations] of services for the treatment
177 of autism spectrum disorder qualify for disbursements from the account for services rendered;
178 and
179 (iii) authorization of all other distributions from the account, except that disbursements
180 for expenses authorized under [Subsection] Subsections (6) and (7) shall also require the

181 approval of the executive director.
182 (4) Account money may be used to:
183 (a) assist with the cost of evaluating, and treating [persons] a child between the age of
184 two years and six years with an autism spectrum disorder; and
185 (b) provide [persons] a child between the age of two years and six years with an autism
186 spectrum disorder with treatments that utilize [early intensive behavior therapy; and] applied
187 behavior analysis and other proven effective treatments included under Subsection
188 26-52-202 (4)(b)(ii).
189 [(c) provide grants to persons or organizations for providing the services described in
190 Subsection (4)(a) or (b).]
191 (5) An individual who receives services that are paid for from the account [or who
192 receives services through an organization or provider that receives payment from the account]
193 shall:
194 (a) be a resident of Utah;
195 (b) have been diagnosed by a qualified professional as having an autism spectrum
196 disorder;
197 (c) be [younger than eight] between the age of two years and six years of age; and
198 (d) have a need that can be met within the requirements of this [title] chapter.
199 (6) All actual and necessary operating expenses for the committee and staff shall be
200 paid by the account.
201 (7) [Account] No more than 9% of the account money may [not] be used for
202 administrative or other expenses of the Department of Health [that are not normally provided
203 for by legislative appropriation].
204 (8) All interest and other earnings derived from the account money shall be deposited
205 into the account.
206 (9) The state treasurer shall invest the money in the account under Title 51, Chapter 7,
207 State Money Management Act.
208 Section 5. Section 26-52-202 is amended to read:
209 26-52-202. Autism Treatment Account Advisory Committee -- Membership --
210 Time limit.
211 (1) (a) There is created an Autism Treatment Account Advisory Committee consisting

212 of [five] six members appointed by the governor to two-year terms of office as follows:
213 (i) one person holding a doctorate degree who has experience in treating persons with
214 an autism spectrum disorder;
215 (ii) one person who is a Board Certified Behavior Analyst;
216 [(ii)] (iii) one person who is a physician licensed under Title 58, Chapter 67, Utah
217 Medical Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act, who has
218 completed a residency program in pediatrics;
219 [(iii)] (iv) one person who is employed in the Department of Health; and
220 [(iv)] (v) two persons from the community who are familiar with autism spectrum
221 disorders and their effects, diagnosis, treatment, rehabilitation, and support needs, including:
222 (A) family members of a person with an autism spectrum disorder;
223 (B) representatives of an association which advocates for persons with an autism
224 spectrum disorder; and
225 (C) specialists or professionals who work with persons with autism spectrum disorders.
226 (b) Notwithstanding the requirements of Subsection (1)(a), the governor shall, at the
227 time of appointment or reappointment, adjust the length of terms to ensure that the terms of
228 committee members are staggered so that approximately half of the committee is appointed
229 every year.
230 (c) If a vacancy occurs in the committee membership for any reason, a replacement
231 may be appointed for the unexpired term.
232 (2) The department shall provide staff support to the committee.
233 (3) (a) The committee shall elect a chair from the membership on an annual basis.
234 (b) A majority of the committee constitutes a quorum at any meeting, and, if a quorum
235 exists, the action of the majority of members present shall be the action of the committee.
236 (c) The executive director may remove a committee member:
237 (i) if the member is unable or unwilling to carry out the member's assigned
238 responsibilities; or
239 (ii) for good cause.
240 (4) The committee may, in accordance with Title 63G, Chapter 3, Utah Administrative
241 Rulemaking Act, make rules governing the committee's activities, which rules shall:
242 (a) comply with the requirements of this title; and

243 (b) include:
244 (i) qualification criteria and procedures for selecting [service and treatment providers
245 that receive disbursements from the account, which criteria shall give additional consideration
246 to providers that are willing to use low interest loans when providing services to individuals;
247 and] children who may qualify for assistance from the account;
248 (ii) qualifications, criteria, and procedures for evaluating the services and providers to
249 include in the program, which shall include at least:
250 (A) applied behavior analysis provided by or supervised by a Board Certified Behavior
251 Analyst;
252 (B) collaboration with existing tele-health networks to reach children in rural and
253 under-served areas of the state; and
254 (C) methods to engage family members in the treatment process; and
255 [(ii)] (iii) provisions to address and avoid conflicts of interest that may arise in relation
256 to[:] the committee's work.
257 [(A) the committee's selection of providers and persons that receive referrals,
258 disbursements, or assistance from the account; and]
259 [(B) other matters that may constitute a conflict of interest.]
260 (5) The committee shall meet as necessary to carry out its duties and shall meet upon a
261 call of the committee chair or a call of a majority of the committee members[, but no more than
262 four times per year].
263 (6) The committee shall comply with the procedures and requirements of:
264 (a) Title 52, Chapter 4, Open and Public Meetings Act; and
265 (b) Title 63G, Chapter 2, Government Records Access and Management Act.
266 (7) Committee members shall receive no compensation or per diem allowance for their
267 services.
268 (8) (a) Not later than November 30 of each year, the committee shall provide a written
269 report summarizing the activities of the committee to:
270 [(a)] (i) the executive director of the department;
271 [(b)] (ii) the Legislature's Health and Human Services Interim Committee; and
272 [(c)] (iii) the Legislature's Health and Human Services Appropriations Subcommittee.
273 (b) The report under Subsection (8)(a) shall include:

274 (i) the number of children diagnosed with autism spectrum disorder who are receiving
275 services under this chapter;
276 (ii) the types of services provided to children under this chapter; and
277 (iii) results of any evaluations on the effectiveness of treatments and services provided
278 under this chapter.
279 Section 6. Section 26-52-203 is enacted to read:
280 26-52-203. Administration of services for eligible individuals.
281 (1) (a) The department shall establish a mechanism to:
282 (i) identify the children who are eligible to receive services from the account in
283 accordance with the standards for eligibility established in rules adopted by the committee
284 under Subsection 26-52-202 (4); and
285 (ii) review and pay for services provided to a child under this chapter.
286 (b) The department may contract with another state agency or a private entity to assist
287 with the mechanism to identify eligible children, provide for services, and pay for services.
288 (2) The department, or the entity selected to assist the department under Subsection (1)
289 may negotiate with providers of the services that are eligible under this chapter to maximize
290 efficiencies and quality of services to children.
291 Section 7. Section 49-20-411 is enacted to read:
292 49-20-411. Autism Pilot Program.
293 (1) As used in this section:
294 (a) "Applied behavior analysis" means the design, implementation, and evaluation of
295 environmental modifications, using behavioral stimuli and consequences, to produce socially
296 significant improvement in human behavior, including the use of direct observation,
297 measurement, and functional analysis of the relationship between environment and behavior
298 that are:
299 (i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
300 functioning of an individual; and
301 (ii) provided or supervised by a board certified behavior analyst or a licensed
302 psychologist with equivalent university training and supervised experience.
303 (b) "Autism spectrum disorder" means a pervasive developmental disorder, as defined
304 by the most recent edition of the Diagnostic and Statistical Manual on Mental Disorders,

305 including:
306 (i) autistic disorder;
307 (ii) asperger's disorder; and
308 (iii) pervasive developmental disorder not otherwise specified.
309 (c) "Treatment of autism spectrum disorders" means any treatment generally accepted
310 by the medical community or the American Academy of Pediatrics as an effective treatment for
311 an individual with an autism spectrum disorder, including applied behavior analysis.
312 (2) (a) Beginning July 1, 2012 and ending July 1, 2014, the state employee risk pool
313 described in Section 49-20-202 (1)(a) shall provide to state employees, treatment for the
314 coverage of autism spectrum disorders in accordance with Subsection (2)(b) for up to 50
315 children:
316 (i) who, by July 1, 2012, are between the age of two to six years old: and
317 (ii) who are enrolled in the pilot program on or before July 1, 2012.
318 (b) The autism services provided in this pilot program shall include:
319 (i) diagnosis of autism spectrum disorder by a physician or qualified mental health
320 professional, and the development of a treatment plan; H. and .H
321 (ii) applied behavior analysis provided by a certified behavior analyst or someone with
322 equivalent training for a child with an autism spectrum disorder;
323 (c) an annual maximum benefit of $30,000 for autism spectrum disorder treatments
324 with co-insurance:
325 (i) of 80/20; and
326 (ii) which does not apply towards the out of pocket maximum for medical insurance;
327 (d) a $250 annual deductible that is separate from the annual medical deductible; H. and .H
328 (e) a $150 per day maximum for treatment of autism spectrum disorder under
329 Subsection (1)(c).
330 Section 8. Appropriation.
331 Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, the
332 following sums of money are appropriated from resources not otherwise appropriated, or
333 reduced from amounts previously appropriated, out of the funds or accounts indicated for the
334 fiscal year beginning July 1, 2011 and ending June 30, 2012. These are additions to any
335 amounts previously appropriated for fiscal year 2012.

336 To Department of Human Services - Child and Family Services
337 From General Fund, One-time

($1,500,000)

338 Schedule of Programs:
339 Service Delivery ($1,500,000)
340 To Department of Health - Medicaid Optional Services
341 From General Fund, One-time

$1,500,000

342 Schedule of Programs:
343 Other Optional Services $1,500,000
344 The Legislature intends that the Department of Health use the appropriation of
345 $1,500,000 to provide services and treatment for children with autism spectrum disorder
346 between the age of two to six years within Medicaid.
347 Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
348 $3,000,000 of appropriations provided for the Department of Health - Medicaid Mandatory
349 Services line item not lapse at the close of Fiscal Year 2012. The use of any nonlapsing funds
350 is limited to a pilot project to provide services and treatment for children with autism spectrum
351 disorder between the age of two to six years.
352 Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
353 $6,000,000 of appropriations provided for the Department of Health - Medicaid Optional
354 Services line item not lapse at the close of Fiscal Year 2012. The use of any nonlapsing funds
355 is limited to a pilot project to provide services and treatment for children with autism spectrum
356 disorder between the age of two to six years.
357 Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
358 $3,000,000 of appropriations provided for the Department of Health - Medicaid Mandatory
359 Services line item not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds
360 is limited to a pilot project to provide services and treatment for children with autism spectrum
361 disorder between the age of two to six years.
362 Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
363 $6,000,000 of appropriations provided for the Department of Health - Medicaid Optional
364 Services line item not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds
365 is limited to a pilot project to provide services and treatment for children with autism spectrum
366 disorder between the age of two to six years.

367 The Legislature intends that the Department of Health provide services and treatment
368 for children with autism spectrum disorder between the age of two to six years within Medicaid
369 from nonlapsing funds provided for this purpose up to a maximum of $6,000,000 in state
370 funds. The department shall inform the Legislature if expenditures by line item for these
371 services require a subsequent transfer of nonlapsing funds.
372 Under Section 63J-1-603 of the Utah Code, the Legislature intends that the cost of
373 services for the autism treatment pilot program in Section 49-20-411 shall be paid for from the
374 surplus in the public employees' state risk pool contingency reserve.