7 Karen Kwan
9 LONG TITLE
10 General Description:
11 This bill amends the Utah Children's Health Insurance Act.
12 Highlighted Provisions:
13 This bill:
14 ▸ adds treatment for autism spectrum disorder to the program benefits within the Utah
15 Children's Health Insurance Program.
16 Money Appropriated in this Bill:
18 Other Special Clauses:
20 Utah Code Sections Affected:
22 26-40-106, as last amended by Laws of Utah 2020, Chapter 225
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 26-40-106 is amended to read:
26 26-40-106. Program benefits.
27 (1) Except as provided in Subsection (3), medical and dental program benefits shall be
28 benchmarked, in accordance with 42 U.S.C. Sec. 1397cc, as follows:
29 (a) medical program benefits, including behavioral health care benefits, shall be
30 benchmarked effective July 1, 2019, and on July 1 every third year thereafter, to:
31 (i) be substantially equal to a health benefit plan with the largest insured commercial
32 enrollment offered by a health maintenance organization in the state; and
33 (ii) comply with the Mental Health Parity and Addiction Equity Act, Pub. L. No.
34 110-343; and
35 (b) dental program benefits shall be benchmarked effective July 1, 2019, and on July 1
36 every third year thereafter in accordance with the Children's Health Insurance Program
37 Reauthorization Act of 2009, to be substantially equal to a dental benefit plan that has the
38 largest insured, commercial, non-Medicaid enrollment of covered lives that is offered in the
39 state, except that the utilization review mechanism for orthodontia shall be based on medical
41 (2) On or before July 1 of each year, the department shall publish the benchmark for
42 dental program benefits established under Subsection (1)(b).
43 (3) The program benefits:
44 (a) for enrollees who are at or below 100% of the federal poverty level are exempt
45 from the benchmark requirements of Subsections (1) and (2)[
46 (b) shall include treatment for autism spectrum disorder as defined in Section
47 31A-22-642, which:
48 (i) shall include coverage for applied behavioral analysis; and
49 (ii) if the benchmark described in Subsection (1)(a) does not include the coverage
50 described in this Subsection (3)(b), the department shall exclude from the benchmark described
51 in Subsection (1)(a) for any purpose other than providing benefits under the program.