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H.B. 69






Chief Sponsor: Ronda Rudd Menlove

Senate Sponsor: ____________

             8      LONG TITLE
             9      General Description:
             10          This bill amends the Accident and Health Insurance part of the Insurance Code to
             11      provide coverage for treatment of autism spectrum disorders.
             12      Highlighted Provisions:
             13          This bill:
             14          .    defines terms;
             15          .    requires that an accident or health insurance policy that provides a health insurance
             16      benefit shall provide coverage for treatment of autism spectrum disorders;
             17          .    grants rulemaking authority to the Insurance Commissioner;
             18          .    describes minimum coverage amounts and limits for the insurance coverage
             19      required by this bill;
             20          .    provides for annual adjustment of the coverage amounts based on the Consumer
             21      Price Index; and
             22          .    limits the coverage if the Patient Protection and Affordable Care Act's
             23      determination of essential health benefits would require the state to pay premium
             24      subsidies related to autism coverage.
             25      Money Appropriated in this Bill:
             26          None
             27      Other Special Clauses:

             28          None
             29      Utah Code Sections Affected:
             30      ENACTS:
             31          31A-22-640, Utah Code Annotated 1953
             33      Be it enacted by the Legislature of the state of Utah:
             34          Section 1. Section 31A-22-640 is enacted to read:
             35          31A-22-640. Insurance coverage for autism spectrum disorders.
             36          (1) As used in this section:
             37          (a) "Applied behavior analysis" means the design, implementation, and evaluation of
             38      environmental modifications, using behavioral stimuli and consequences, to produce socially
             39      significant improvement in human behavior, including the use of direct observation,
             40      measurement, and functional analysis of the relationship between environment and behavior
             41      that are:
             42          (i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
             43      functioning of an individual; and
             44          (ii) provided or supervised by a board certified behavior analyst or a licensed
             45      psychologist with equivalent university training and supervised experience.
             46          (b) "Autism spectrum disorder" means a pervasive developmental disorder, as defined
             47      by the most recent edition of the Diagnostic and Statistical Manual on Mental Disorders,
             48      including:
             49          (i) autistic disorder;
             50          (ii) asperger's disorder; and
             51          (iii) pervasive developmental disorder not otherwise specified.
             52          (c) "Consumer price index" is as described in Section 1(f)(4), Internal Revenue Code,
             53      and defined in Section 1(f)(5), Internal Revenue Code.
             54          (d) "PPACA" means the Patient Protection and Affordable Care Act, Pub. L. No.
             55      111-148, the Health Care Education Reconciliation Act of 2010, Pub. L. No. 111-152, and
             56      federal regulation to implement the act.
             57          (e) "Treatment of autism spectrum disorders" means any treatment generally accepted
             58      by the medical community or the American Academy of Pediatrics as an effective treatment for

             59      an individual with an autism spectrum disorder, including:
             60          (i) applied behavior analysis;
             61          (ii) pharmaceuticals;
             62          (iii) psychiatric treatment;
             63          (iv) psychological treatment;
             64          (v) occupational therapy;
             65          (vi) speech therapy; and
             66          (vii) medical treatment.
             67          (2) An accident or health insurance policy issued or renewed on or after January 1,
             68      2013, that provides a health insurance benefit shall provide coverage for treatment of autism
             69      spectrum disorders in accordance with the requirements of this section and rules made by the
             70      commissioner under this section.
             71          (3) The commissioner shall make rules, in accordance with Title 63G, Chapter 3, Utah
             72      Administrative Rulemaking Act, that set minimum standards of coverage for the treatment of
             73      autism spectrum disorders.
             74          (4) (a) Subject to Subsections (4)(b), (5), and (6), the rules described in Subsection (3)
             75      shall establish durational limits, amount limits, deductibles, and coinsurance for the treatment
             76      of autism spectrum disorders that are similar to, or identical to, the coverage provided for other
             77      illnesses or diseases.
             78          (b) An accident or health insurance policy may not deny treatment of autism spectrum
             79      disorder on the basis that the treatment is habilitative or non-restorative in nature.
             80          (5) (a) Subject to Subsection (6), an accident or health insurance policy that provides a
             81      health insurance benefit shall provide coverage for the provision of applied behavior analysis
             82      for a person with an autism spectrum disorder of at least $50,000 annually.
             83          (b) Payments made by an insurer on behalf of a covered individual for treatment other
             84      than applied behavior analysis shall not be applied to the annual limit under Subsection (5)(a).
             85          (6) (a) Beginning on July 1, 2015, the commissioner has the authority to annually
             86      adjust the amounts described in Subsection (5) by a percentage equal to the percentage
             87      difference between the consumer price index for the current calendar year and the consumer
             88      price index for the preceding calendar year.
             89          (b) (i) The commissioner has authority to adjust the coverage required under

             90      Subsection (4) for qualified health plans offered in the individual market on the Utah Health
             91      Exchange if PPACA would require the state to pay the portion of an individual's premium
             92      subsidy that is attributable to the autism spectrum disorder coverage required by Subsections
             93      (4) and (5).
             94          (ii) If the commissioner adjusts the coverage for autism spectrum disorders under the
             95      provisions of Subsection (6)(b), the coverage shall be adjusted only to the extent necessary to
             96      keep the state from having to pay premium subsidies associated with coverage of autism
             97      spectrum disorders in qualified health plans offered in the individual market on the Utah Health
             98      Exchange.

Legislative Review Note
    as of 1-13-12 7:08 PM

Office of Legislative Research and General Counsel

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