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8 LONG TITLE
9 General Description:
10 This bill amends the Public Employees' Benefit and Insurance Program Act to create a
11 pilot program to provide coverage for treatment of autism spectrum disorders.
12 Highlighted Provisions:
13 This bill:
14 . defines terms;
15 . requires the Public Employees' Benefit and Insurance Program to establish a pilot
16 program to provide coverage for treatment of autism spectrum disorders;
17 . describes minimum coverage amounts and limits for the autism coverage required
18 by this bill;
19 . provides for annual adjustment of the coverage amounts described in the preceding
20 paragraph, based on the Consumer Price Index during the pilot program; and
21 . sunsets the pilot program on July 1, 2022.
22 Money Appropriated in this Bill:
24 Other Special Clauses:
26 Utah Code Sections Affected:
28 49-20-411, Utah Code Annotated 1953
29 63I-1-249, Utah Code Annotated 1953
31 Be it enacted by the Legislature of the state of Utah:
32 Section 1. Section 49-20-411 is enacted to read:
33 49-20-411. Insurance coverage for autism spectrum disorders.
34 (1) As used in this section:
35 (a) "Autism spectrum disorder" means a pervasive developmental disorder, as defined
36 by the most recent edition of the Diagnostic and Statistical Manual on Mental Disorders,
38 (i) Autistic Disorder;
39 (ii) Asperger's Disorder; and
40 (iii) Pervasive Developmental Disorder Not Otherwise Specified.
41 (b) "Consumer price index" is as described in Section 1(f)(4), Internal Revenue Code,
42 and defined in Section 1(f)(5), Internal Revenue Code.
43 (c) "Early intensive behavior therapy" means therapy that:
44 (i) involves intensive behavioral intervention over an extended period of time;
45 (ii) is evidence-based; and
46 (iii) is generally accepted by the medical community or the American Academy of
47 Pediatrics as an effective treatment for young children with an autism spectrum disorder.
48 (d) "Treatment of autism spectrum disorders" means any treatment generally accepted
49 by the medical community or the American Academy of Pediatrics as an effective treatment for
50 children with an autism spectrum disorder, including:
51 (i) habilitative or rehabilitative treatment;
52 (ii) early intensive behavior therapy;
53 (iii) pharmaceuticals;
54 (iv) psychiatric treatment;
55 (v) psychological treatment;
56 (vi) therapeutic treatment;
57 (vii) occupational therapy;
58 (viii) speech therapy; or
59 (ix) medical treatment.
60 (2) Beginning July 1, 2012, an employee benefit plan that provides a health insurance
61 benefit shall provide coverage for treatment of autism spectrum disorders in accordance with
62 the requirements of this section.
63 (3) The office shall set minimum standards of coverage for the treatment of autism
64 spectrum disorders which establish durational limits, amount limits, deductibles, and
65 coinsurance for the treatment of autism spectrum disorders that are similar to, or identical to,
66 the coverage provided for other illnesses or diseases.
67 (4) Subject to Subsection (5), an accident or health insurance policy that provides a
68 health insurance benefit shall provide coverage for the provision of early intensive behavior
69 therapy for a person with an autism spectrum disorder of at least:
70 (a) $50,000 annually for a child who is less than nine years old; and
71 (b) $25,000 annually for a child who is at least nine years old, but less than 17 years
73 (5) Beginning on July 1, 2013, the commissioner has the authority to annually adjust
74 the amounts described in Subsection (4) by a percentage equal to the percentage difference
75 between the consumer price index for the current calendar year and the consumer price index
76 for the preceding calendar year.
77 (6) The pilot program created in this section is subject to a sunset review under Section
78 63I-1-249 .
79 Section 2. Section 63I-1-249 is enacted to read:
80 63I-1-249. Repeal dates, Title 49.
81 Section 49-20-411 is repealed July 1, 2022.
Legislative Review Note
as of 10-3-11 3:41 PM