2012 Utah Code
Title 49 - Utah State Retirement and Insurance Benefit Act
Article 20 - Public Employees' Benefit and Insurance Program Act
Section 411 - Autism Pilot Program.

(1) As used in this section:

(a) "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, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior 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 board certified behavior analyst or a licensed psychologist with equivalent university training and supervised experience.

(b) "Autism spectrum disorder" means a pervasive developmental disorder, as defined by the most recent edition of the Diagnostic and Statistical Manual on Mental Disorders, including:

(i) autistic disorder;

(ii) asperger's disorder; and

(iii) a pervasive developmental disorder not otherwise specified.

(c) "Treatment of autism spectrum disorders" means any treatment generally accepted by the medical community or the American Academy of Pediatrics as an effective treatment for an individual with an autism spectrum disorder, including applied behavior analysis.

(2) (a) Beginning July 1, 2012 and ending July 1, 2014, the Public Employees' Benefit and Insurance Program shall provide a pilot program for the treatment of autism spectrum disorders in accordance with Subsection (2)(b) for up to 50 children who:

(i) are between the age of two and six years old by July 1, 2012;

(ii) enroll in the pilot program on or before July 1, 2012; and

(iii) have a parent who is a state employee and is enrolled in a health plan that was offered under this chapter on or before January 1, 2012.

(b) The autism services provided in this pilot program shall include:

(i) diagnosis of autism spectrum disorder by a physician or qualified mental health professional, and the development of a treatment plan;

(ii) applied behavior analysis provided by a certified behavior analyst or someone with equivalent training for a child with an autism spectrum disorder; and

(iii) an annual maximum benefit of $30,000 for autism spectrum disorder treatments with the following cost sharing from the parents of the child with autism spectrum disorder:

(A) the parents will pay the first $250 of expenses for autism treatments provided by the pilot program;

(B) the pilot program will pay 80% of the cost of the treatment after the first $250, and the parents will pay 20% of the cost of treatment; and

(C) the pilot program will pay a maximum of a $150 per day for treatment of autism spectrum disorder under Subsection (1)(c).

(3) The autism pilot program is a limited pilot to study the efficacy of providing autism treatment and is not a mandate for coverage of autism treatment within the health plans offered by the Public Employees' Benefit and Insurance Program.

Enacted by Chapter 402, 2012 General Session