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H.B. 88

This document includes House Committee Amendments incorporated into the bill on Mon, Feb 10, 2014 at 12:27 PM by jeyring. -->              1     

AUTISM PROGRAM AMENDMENTS

             2     
2014 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Ronda Rudd Menlove

             5     
Senate Sponsor: Curtis S. Bramble

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends provisions of the Utah Health Code and the Utah State Retirement and
             10      Insurance Benefit Act related to programs for the treatment of autism spectrum
             11      disorder.
             12      Highlighted Provisions:
             13          This bill:
             14          .    requires the Department of Health to establish, through a Medicaid waiver, an
             15      ongoing program for the treatment of qualified children with autism spectrum
             16      disorder;
             17          .    requires the Public Employee Insurance and Benefit Program to establish an
             18      ongoing program for the treatment of qualified children with autism spectrum
             19      disorder; and
             20          .    makes technical and conforming amendments.
             21      Money Appropriated in this Bill:
             22          None
             23      Other Special Clauses:
             24          None
             25      Utah Code Sections Affected:
             26      AMENDS:
             27           26-18-407 , as enacted by Laws of Utah 2012, Chapter 402


             28           26-52-102 , as last amended by Laws of Utah 2012, Chapter 402
             29           26-52-201 , as last amended by Laws of Utah 2012, Chapter 402
             30           26-52-202 , as last amended by Laws of Utah 2012, Chapters 242 and 402
             31           26-52-203 , as enacted by Laws of Utah 2012, Chapter 402
             32           49-20-411 , as enacted by Laws of Utah 2012, Chapter 402
             33     
             34      Be it enacted by the Legislature of the state of Utah:
             35          Section 1. Section 26-18-407 is amended to read:
             36           26-18-407. Medicaid waiver for autism spectrum disorder.
             37          (1) [For purposes of] As used in this section ["autism]:
             38          (a) "Autism spectrum disorder" [means a pervasive developmental disorder] is as
             39      defined by the most recent edition of the Diagnostic and Statistical Manual on Mental
             40      Disorders H. or a recent edition of a professionally accepted diagnostic manual .H
             40a      [, including:].
             41          [(a) autistic disorder;]
             42          [(b) asperger's disorder; and]
             43          [(c) pervasive developmental disorder not otherwise specified.]
             44          (b) "Program" means the autism spectrum disorder program created in Subsection (3).
             45          (c) "Qualified child" means a child who is:
             46          (i) at least two years of age but less than seven years of age; and
             47          (ii) diagnosed with an autism spectrum disorder by a qualified professional.
             48          (2) The department shall, [by July 1, 2012,] apply for a Medicaid waiver with the
             49      Centers for Medicare and Medicaid Services within the United States Department of Health
             50      and Human Services to implement [an autism spectrum disorders program], within the state
             51      Medicaid program, the program described in Subsection (3).
             52          [(3) The autism spectrum disorders waiver program shall:]
             53          [(a) provide services to children between the ages of two years and six years with
             54      autism spectrum disorders;]
             55          (3) The department shall offer an autism spectrum disorder program that:
             56          (a) as funding permits, provides treatment for autism spectrum disorders to qualified
             57      children; and
             58          (b) [accept] accepts applications for the program during periods of open enrollment[;].


             59          [(c) initially provide services for up to 500 children, as funding permits;]
             60          (4) The department shall:
             61          [(d)] (a) convene a public process with the Department of Human Services to [develop]
             62      determine the benefits and services [to include in the autism waiver program, including] the
             63      program shall offer qualified children that considers, in addition to any other relevant factor:
             64          (i) demonstrated effective treatments;
             65          (ii) methods to engage family members in the treatment process; and
             66          (iii) outreach to qualified children in rural and underserved areas of the state; and
             67          [(e) include a mechanism to]
             68          (b) evaluate the [cost, effectiveness, and outcomes of the different services provided as
             69      part of the autism waiver] ongoing results, cost, and effectiveness of the program.
             70          [(4)] (5) The department shall annually report to the Legislature's Health and Human
             71      Services Interim Committee [by November 30, 2013, and prior to] before each November 30
             72      [thereafter] while the waiver is in effect regarding:
             73          (a) the number of [children diagnosed with autism spectrum disorder and the number
             74      of] qualified children served under the waiver;
             75          (b) success involving families in supporting treatment plans for autistic children;
             76          (c) the cost of the [autism waiver] program; and
             77          (d) the [outcomes] results and effectiveness of the [services offered by the autism
             78      waiver] program.
             79          Section 2. Section 26-52-102 is amended to read:
             80           26-52-102. Definitions.
             81          As used in this chapter:
             82          (1) "Account" means the Autism Treatment Account created in Section 26-52-201 .
             83          (2) "Applied behavior analysis" means the design, implementation, and evaluation of
             84      environmental modifications using behavioral stimuli and consequences to produce socially
             85      significant improvement in human behavior, including the use of direct observation,
             86      measurement, and functional analysis of the relationship between environment and behavior
             87      that are:
             88          (a) necessary to develop, maintain, or restore, to the maximum extent practicable, the
             89      functioning of an individual; and


             90          (b) provided or supervised by H. , for the purposes of the program, .H a:
             91          (i) board certified behavior analyst; or
             92          (ii) a licensed psychologist with equivalent university training and supervised
             93      experience who is working toward board certification in applied behavior analysis.
             94          (3) "Autism spectrum disorder" [means a pervasive developmental disorder] is as
             95      defined by the most recent edition of the Diagnostic and Statistical Manual on Mental
             96      Disorders H. or a recent edition of a professionally accepted diagnostic manual .H [,
             96a      including:].
             97          [(a) autistic disorder;]
             98          [(b) asperger's disorder; and]
             99          [(c) pervasive developmental disorder not otherwise specified.]
             100          (4) "Committee" means the Autism Treatment Account Advisory Committee created
             101      under Section 26-52-202 .
             102          (5) "Program" means the services offered by the committee using funds from the
             103      account.
             104          (6) "Qualified child" means a child who:
             105          (a) is at least two years of age but less than seven years of age;
             106          (b) is diagnosed with an autism spectrum disorder; and
             107          (c) meets the other qualification criteria established by the committee under Subsection
             108      26-52-202 (4).
             109          (7) "Treatment" means the treatment of autism spectrum disorder.
             110          Section 3. Section 26-52-201 is amended to read:
             111           26-52-201. Autism Treatment Account -- Medical loss ratio calculation -- Use of
             112      account.
             113          (1) There is created within the General Fund a restricted account known as the Autism
             114      Treatment Account.
             115          (2) [(a)] The account shall consist of:
             116          [(i)] (a) gifts, grants, devises, donations, and bequests of real property, personal
             117      property, or services, from any source, or any other conveyance that may be made to the
             118      account from private sources;
             119          [(ii)] (b) interest and other earnings derived from the account money; and
             120          [(iii)] (c) any additional amounts as appropriated by the Legislature.


             121          [(b) (i) For purposes of this subsection, the Affordable Care Act is as defined in
             122      Section 31A-2-212 .]
             123          [(ii)] (3) If an insurer contributes to the [Autism Treatment Account] account, for
             124      purposes of calculating an insurer's medical loss ratio under the [Affordable Care Act,]
             125      PPACA, as defined in Section 31A-1-301 , the insurance commissioner shall consider the
             126      contribution to the [Autism Treatment Account as] account to be a claims payment by the
             127      insurer.
             128          [(3) (a)] (4) Except as provided [under] in Subsection [(3)(b)] (5), the executive
             129      director of the department shall be responsible for administering the account.
             130          [(b)] (5) The committee shall [be responsible for the following actions in relation to the
             131      account], consistent with the requirements of this title:
             132          [(i) prioritizing and allocating uses for account money,]
             133          (a) prioritize spending of account funds, as permitted under Subsection [(4)] (6);
             134          [(ii) determining which providers of services for the treatment of autism spectrum
             135      disorder]
             136          (b) determine which treatment providers qualify for disbursements from the account
             137      for services rendered; and
             138          [(iii) authorization of]
             139          (c) authorize all other distributions from the account, except that disbursements for
             140      expenses authorized under Subsections [(6) and (7)] (6)(b) and (c) shall also require the
             141      approval of the executive director.
             142          [(4)] (6) Account money may be used to:
             143          [(a) assist with the cost of evaluating and treating a child between the age of two and
             144      six years with an autism spectrum disorder; and]
             145          [(b) provide a child between the age of two and six years with an autism spectrum
             146      disorder with treatments that utilize]
             147          (a) evaluate and treat a qualified child by utilizing applied behavior analysis [and] or
             148      other proven effective treatments [included under] as determined by the committee under
             149      Subsection 26-52-202 (4)(b)[(ii).];
             150          [(5) An individual who receives services that are paid for from the account shall:]
             151          [(a) be a resident of Utah;]


             152          [(b) have been diagnosed by a qualified professional as having an autism spectrum
             153      disorder;]
             154          [(c) be between the age of two and six years; and]
             155          [(d) have a need that can be met within the requirements of this chapter.]
             156          [(6) All] (b) pay all actual and necessary operating expenses for the committee and
             157      staff [shall be paid by the account.]; and
             158          [(7) No more than 9% of the account money may be used for]
             159          (c) pay administrative or other expenses of the Department of Health related to the
             160      program, except where those expenses are greater than 9% of the total account funds.
             161          [(8)] (7) All interest and other earnings derived from the account money shall be
             162      deposited into the account.
             163          [(9)] (8) The state treasurer shall invest the money in the account under Title 51,
             164      Chapter 7, State Money Management Act.
             165          Section 4. Section 26-52-202 is amended to read:
             166           26-52-202. Autism Treatment Account Advisory Committee -- Membership --
             167      Time limit.
             168          (1) (a) There is created an Autism Treatment Account Advisory Committee consisting
             169      of six members appointed by the governor to two-year terms of office as follows:
             170          (i) one [person] individual holding a doctorate degree who has experience in treating
             171      persons with an autism spectrum disorder;
             172          (ii) one [person who is a] board certified behavior analyst;
             173          (iii) one [person who is a] physician licensed under Title 58, Chapter 67, Utah Medical
             174      Practice Act, or Title 58, Chapter 68, Utah Osteopathic Medical Practice Act, who has
             175      completed a residency program in pediatrics;
             176          (iv) one [person who is employed in] employee of the Department of Health; and
             177          (v) two [persons from the community] individuals who are familiar with autism
             178      spectrum disorders and their effects, diagnosis, treatment, rehabilitation, and support needs,
             179      including:
             180          (A) family members of a person with an autism spectrum disorder;
             181          (B) representatives of an association which advocates for persons with an autism
             182      spectrum disorder; and


             183          (C) specialists or professionals who work with persons with autism spectrum disorders.
             184          (b) Notwithstanding the requirements of Subsection (1)(a), the governor shall, at the
             185      time of appointment or reappointment, adjust the length of terms to ensure that the terms of
             186      committee members are staggered so that approximately half of the committee is appointed
             187      every year.
             188          (c) If a vacancy occurs in the committee membership for any reason, [a replacement
             189      may be appointed] the governor may appoint a replacement for the unexpired term.
             190          (2) The department shall provide staff support to the committee.
             191          (3) (a) The committee shall elect a chair from the membership on an annual basis.
             192          (b) A majority of the committee constitutes a quorum at any meeting, and, if a quorum
             193      exists, the action of the majority of members present shall be the action of the committee.
             194          (c) The executive director may remove a committee member:
             195          (i) if the member is unable or unwilling to carry out the member's assigned
             196      responsibilities; or
             197          (ii) for good cause.
             198          (4) The committee [may] shall, in accordance with Title 63G, Chapter 3, Utah
             199      Administrative Rulemaking Act, make rules governing the committee's activities[, which rules
             200      shall: (a)] that comply with the requirements of this title[; and], including rules that:
             201          [(b) include:]
             202          [(i) qualification criteria and procedures for selecting children who may qualify for
             203      assistance from the account;]
             204          [(ii) qualifications, criteria, and procedures for evaluating the services and providers to
             205      include in the program, which shall include at least:]
             206          (a) establish criteria and procedures for selecting qualified children to participate in the
             207      program;
             208          (b) establish the services, providers, and treatments to include in the program, and the
             209      qualifications, criteria, and procedures for evaluating the providers and treatments; and
             210          (c) address and avoid conflicts of interest that may arise in relation to the committee
             211      and its duties.
             212          (5) As part of its duties under Subsection 26-52-201 (5), the committee shall, at
             213      minimum:


             214          [(A)] (a) offer applied behavior analysis provided by or supervised by a board certified
             215      behavior analyst or a licensed psychologist with equivalent university training and supervised
             216      experience;
             217          [(B) collaboration] (b) collaborate with existing telehealth networks to reach children
             218      in rural and under-served areas of the state; and
             219          [(C) methods to] (c) engage family members in the treatment process[; and].
             220          [(iii) provisions to address and avoid conflicts of interest that may arise in relation to
             221      the committee's work.]
             222          [(5)] (6) The committee shall meet as necessary to carry out its duties and shall meet
             223      upon a call of the committee chair or a call of a majority of the committee members.
             224          [(6)] (7) The committee shall comply with the procedures and requirements of:
             225          (a) Title 52, Chapter 4, Open and Public Meetings Act; and
             226          (b) Title 63G, Chapter 2, Government Records Access and Management Act.
             227          [(7)] (8) Committee members [shall receive no] may not receive compensation or per
             228      diem allowance for their services.
             229          [(8) (a)] (9) Not later than November 30 of each year, the committee shall provide a
             230      written report summarizing the activities of the committee to:
             231          [(i)] (a) the executive director of the department;
             232          [(ii)] (b) the Legislature's Health and Human Services Interim Committee; and
             233          [(iii)] (c) the Legislature's Social Services Appropriations Subcommittee.
             234          [(b)] (10) The report under Subsection [(8) (a)] (9) shall include:
             235          [(i)] (a) the number of children diagnosed with autism spectrum disorder who are
             236      receiving services under this chapter;
             237          [(ii)] (b) the types of services provided to qualified children under this chapter; and
             238          [(iii)] (c) results of any evaluations on the effectiveness of treatments and services
             239      provided under this chapter.
             240          Section 5. Section 26-52-203 is amended to read:
             241           26-52-203. Administration of services for eligible individuals.
             242          (1) [(a)] The department shall establish [a mechanism] procedures to:
             243          [(i)] (a) identify the qualified children who are eligible to receive services from the
             244      account in accordance with the standards for eligibility established in rules adopted by the


             245      committee under Subsection 26-52-202 (4); and
             246          [(ii)] (b) review and pay for services provided to a qualified child under this chapter.
             247          [(b)] (2) The department may contract with another state agency or a private entity to
             248      [assist with the mechanism to] identify [eligible] qualified children, provide for services, and
             249      pay for services.
             250          [(2)] (3) The department, or [the entity selected to assist the department] an entity
             251      contracted under Subsection [(1)] (2), may negotiate with providers of the services [that are
             252      eligible] offered under this chapter to maximize [efficiencies] the efficiency and quality of
             253      services offered to qualified children.
             254          Section 6. Section 49-20-411 is amended to read:
             255           49-20-411. Autism Spectrum Disorder Treatment Program.
             256          (1) As used in this section:
             257          (a) "Applied behavior analysis" means the design, implementation, and evaluation of
             258      environmental modifications using behavioral stimuli and consequences to produce socially
             259      significant improvement in human behavior, including the use of direct observation,
             260      measurement, and functional analysis of the relationship between environment and behavior
             261      that are:
             262          (i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
             263      functioning of an individual; and
             264          (ii) provided or supervised by a board certified behavior analyst or a licensed
             265      psychologist with equivalent university training and supervised experience.
             266          (b) "Autism spectrum disorder" [means a pervasive developmental disorder,] is as
             267      defined by the most recent edition of the Diagnostic and Statistical Manual on Mental
             268      Disorders H. or a recent edition of a professionally accepted diagnostic manual .H
             268a      [, including:].
             269          [(i) autistic disorder;]
             270          [(ii) asperger's disorder; and]
             271          [(iii) a pervasive developmental disorder not otherwise specified.]
             272          (c) "Health plan" does not include the health plan offered by the Public Employees
             273      Benefit and Insurance Program that is the state's designated essential health benefit package for
             274      purposes of the PPACA, as defined in Section 31A-1-401 .
             275          (d) "Parent" means a parent of a qualified child.


             276          (e) "Program" means the autism spectrum disorder treatment program created in
             277      Subsection (2).
             278          (f) "Qualified child" means a child who is:
             279          (i) at least two years of age but less than seven years of age;
             280          (ii) diagnosed with an autism spectrum disorder by a qualified professional; and
             281          (iii) the eligible dependent of a state employee who is enrolled in a health plan that is
             282      offered under this chapter.
             283          [(c)] (g) "Treatment [of autism spectrum disorders]" means any treatment generally
             284      accepted by the medical community or the American Academy of Pediatrics as an effective
             285      treatment for an individual with an autism spectrum disorder, including applied behavior
             286      analysis.
             287          (2) [(a) Beginning July 1, 2012 and ending July 1, 2014, the] The Public Employees'
             288      Benefit and Insurance Program shall [provide] offer a [pilot] program for the treatment of
             289      autism spectrum disorders in accordance with Subsection [(2)(b) for up to 50 children who:]
             290      (3).
             291          [(i) are between the age of two and six years old by July 1, 2012;]
             292          [(ii) enroll in the pilot program on or before July 1, 2012; and]
             293          [(iii) have a parent who is a state employee and is enrolled in a health plan that was
             294      offered under this chapter on or before January 1, 2012.]
             295          [(b) The autism services provided in this pilot program shall include:]
             296          (3) The program shall offer qualified children:
             297          [(i)] (a) diagnosis of autism spectrum disorder by a physician or qualified mental health
             298      professional, and the development of a treatment plan;
             299          [(ii)] (b) applied behavior analysis provided by a certified behavior analyst or someone
             300      with equivalent training [for a child with an autism spectrum disorder]; and
             301          [(iii)] (c) an annual cost-shared maximum benefit of $30,000 [for autism spectrum
             302      disorder treatments with the following cost sharing from the parents of the child with autism
             303      spectrum disorder] toward the cost of treatment that the program covers, where, for each
             304      qualified child, for the cost of the treatment:
             305          [(A) the parents will pay the first $250 of expenses for autism treatments provided by
             306      the pilot program;]


             307          [(B) the pilot program will pay 80% of the cost of the treatment after the first $250, and
             308      the parents will pay 20% of the cost of treatment; and]
             309          [(C) the pilot program will pay a maximum of a $150 per day for treatment of autism
             310      spectrum disorder under Subsection (1)(c).]
             311          (i) the parent pays the first $250;
             312          (ii) after the first $250, the program pays 80% and the parent pays 20%;
             313          (iii) the program pays no more than $150 per day; and
             314          (iv) the program pays no more than $24,000 total.
             315          [(3)] (4) The [autism pilot] purpose of the program is [a limited pilot] to study the
             316      efficacy of providing autism treatment and is not a mandate for coverage of autism treatment
             317      within the health plans offered by the Public Employees' Benefit and Insurance Program.
             318          (5) The program shall be funded on an ongoing basis through the risk pool established
             319      in Subsection 49-20-202 (1)(a).




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