Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 204 (2023GS)

Sponsor

Sen. Bramble, C.

Final action

Governor Signed 3/15/2023

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• defines terms; and
• requires the Department of Health and Human Services to request a state plan amendment for the Medicaid program to provide coverage for autism treatment services.

Every vote on this bill

Bill text

AUTISM COVERAGE AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Curtis S. Bramble
House Sponsor: 
Steve Eliason
LONG TITLE
General Description:
This bill requires the Department of Health and Human Services to request a state plan
amendment for the Medicaid program to provide coverage for autism treatment
services.
Highlighted Provisions:
This bill:
▸ defines terms; and
▸ requires the Department of Health and Human Services to request a state plan
amendment for the Medicaid program to provide coverage for autism treatment
services.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
ENACTS:
26-18-29
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-29
 is enacted to read:
 26-18-29.
Coverage for autism spectrum disorder.
(1) As used in this section:
(a) (i) "Applied behavior analysis" means the design, implementation, and evaluation
of environmental modifications, using behavioral stimuli and consequences, to produce
socially significant improvement in human behavior.
(ii) "Applied behavior analysis" includes the use of direct observation, measurement,
and functional analysis of the relationship between environment and behavior.
(b) "Autism spectrum disorder" means pervasive developmental disorders as defined
by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
(c) "Behavioral health treatment" means counseling and treatment programs, including
applied behavior analysis, that are:
(i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
functioning of an individual; and
(ii) provided or supervised by:
(A) a board certified behavior analyst; or
(B) an individual licensed under Title 58, Occupations and Professions, whose scope of
practice includes mental health services.
(d) "Diagnosis of autism spectrum disorder" means medically necessary assessments,
evaluations, or tests:
(i) performed by:
(A) a licensed physician who is board certified in neurology, psychiatry, or pediatrics
and has experience diagnosing autism spectrum disorder; or
(B) a licensed psychologist with experience diagnosing autism spectrum disorder; and
(ii) necessary to diagnose whether an individual has an autism spectrum disorder.
(e) "Pharmacy care" means medications prescribed by a licensed physician and any
health-related services considered medically necessary to determine the need or effectiveness
of the medications.
(f) "Psychiatric care" means direct or consultative services provided by a psychiatrist
licensed in the state in which the psychiatrist practices.
(g) "Psychological care" means direct or consultative services provided by a
psychologist licensed in the state in which the psychologist practices.
(h) "Therapeutic care" means services provided by a licensed or certified speech
therapist, occupational therapist, or physical therapist.
(i) (i) "Treatment for autism spectrum disorder" means evidence-based care and related
equipment prescribed or ordered for an enrollee diagnosed with an autism spectrum disorder by
a physician or a licensed psychologist described in Subsection (1)(d) who determines the care
to be medically necessary.
(ii) "Treatment for autism spectrum disorder" includes:
(A) behavioral health treatment, provided or supervised by a person described in
Subsection (1)(c)(ii);
(B) pharmacy care;
(C) psychiatric care;
(D) psychological care; and
(E) therapeutic care.
(2) The department shall request a state plan amendment with CMS to provide
treatment for autism spectrum disorder for an enrollee diagnosed with autism spectrum
disorder.