26B-3-225. Coverage for autism spectrum disorder.
(1) |
As used in this section:
Terms Used In Utah Code 26B-3-225- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- CMS: means the Centers for Medicare and Medicaid Services within the United States Department of Health and Human Services. See Utah Code 26B-3-101
- Person: means :Utah Code 68-3-12.5
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(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. |
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(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 |
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(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 |
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(ii) |
necessary to diagnose whether an individual has an autism spectrum disorder. |
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(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); |
(D) |
psychological care; and |
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(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. |
Enacted by Chapter 326, 2023 General Session
Technical renumber of section for proper placement in Title and Chapter.