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Fourth Substitute H.B. 272

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: Curtis S. Bramble

             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 disorders;


             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 disorders.
             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 an autism spectrum disorders 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 applications 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, including:
             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 and six years with an autism spectrum disorder; and
             185          (b) provide [persons] a child between the age of two 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 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) a 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 Public Employees' Benefit
             313      and Insurance Program shall provide a pilot program for the treatment of autism spectrum
             314      disorders in accordance with Subsection (2)(b) for up to 50 children who:
             315          (i) are between the age of two and six years old by July 1, 2012:
             316          (ii) enroll in the pilot program on or before July 1, 2012; and
             317          (iii) have a parent who is enrolled in a health plan that was offered under this chapter
             318      on or before January 1, 2012.
             319          (b) The autism services provided in this pilot program shall include:
             320          (i) diagnosis of autism spectrum disorder by a physician or qualified mental health
             321      professional, and the development of a treatment plan;
             322          (ii) applied behavior analysis provided by a certified behavior analyst or someone with
             323      equivalent training for a child with an autism spectrum disorder; and
             324          (iii) an annual maximum benefit of $30,000 for autism spectrum disorder treatments
             325      with the following cost sharing from the parents of the child with autism spectrum disorder:
             326          (A) the parents will pay the first $250 of expenses for autism treatments provided by
             327      the pilot program;
             328          (B) the pilot program will pay 80% of the cost of the treatment after the first $250, and
             329      the parents will pay 20% of the cost of treatment; and
             330          (C) the pilot program will pay a maximum of a $150 per day for treatment of autism
             331      spectrum disorder under Subsection (1)(c).
             332          (3) The autism pilot program is a limited pilot to study the efficacy of providing autism
             333      treatment and is not a mandate for coverage of autism treatment within the health plans offered
             334      by the Public Employees' Benefit and Insurance Program.
             335          Section 8. Appropriation.


             336          Under the terms and conditions of Title 63J, Chapter 1, Budgetary Procedures Act, the
             337      following sums of money are appropriated from resources not otherwise appropriated, or
             338      reduced from amounts previously appropriated, out of the funds or accounts indicated for the
             339      fiscal year beginning July 1, 2011 and ending June 30, 2012. These are additions to any
             340      amounts previously appropriated for fiscal year 2012.
             341          To Department of Human Services - Child and Family Services
             342              From General Fund, One-time
($1,500,000)

             343              Schedule of Programs:
             344                  Service Delivery                ($1,500,000)
             345          To Department of Health - Medicaid Optional Services
             346              From General Fund, One-time
$1,500,000

             347              Schedule of Programs:
             348                  Other Optional Services            $1,500,000
             349          The Legislature intends that the Department of Health use the appropriation of
             350      $1,500,000 to provide services and treatment for children with autism spectrum disorder
             351      between the age of two to six years within Medicaid.
             352          Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
             353      $3,000,000 of appropriations provided for the Department of Health - Medicaid Mandatory
             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      $6,000,000 of appropriations provided for the Department of Health - Medicaid Optional
             359      Services line item not lapse at the close of Fiscal Year 2012. 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      $3,000,000 of appropriations provided for the Department of Health - Medicaid Mandatory
             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          Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to
             368      $6,000,000 of appropriations provided for the Department of Health - Medicaid Optional
             369      Services line item not lapse at the close of Fiscal Year 2013. The use of any nonlapsing funds
             370      is limited to a pilot project to provide services and treatment for children with autism spectrum
             371      disorder between the age of two to six years.
             372          The Legislature intends that the Department of Health provide services and treatment
             373      for children with autism spectrum disorder between the age of two to six years within Medicaid
             374      from nonlapsing funds provided for this purpose up to a maximum of $6,000,000 in state
             375      funds. The department shall inform the Legislature if expenditures by line item for these
             376      services require a subsequent transfer of nonlapsing funds.
             377          Under Section 63J-1-603 of the Utah Code, the Legislature intends that the cost of
             378      services for the autism treatment pilot program in Section 49-20-411 shall be paid for from the
             379      surplus in the public employees' state risk pool contingency reserve.


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