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Legislation Signed into Law

2014

Primary Focus: Mandated Benefits
Title/Description: Insurance coverage for autism spectrum disorder.
Citation: Utah Code Ann. § 31A-22-642
Summary: The Commissioner may adopt rules to set the minimum standards of coverage for the treatment of autism spectrum disorder. All rules adopted, however, must set forth durational limits, amount limits, deductibles, copayments and coinsurance for such treatment that are similar to, or identical to, the coverage provided for other illnesses or diseases.
Coverage for behavioral health treatment for a person with an autism spectrum disorder shall cover at least 600 hours a year. Other terms and conditions in the health benefit plan that apply to other benefits covered by the health benefit plan apply to coverage required by this section
Effective Date: April 1, 2014 by Ut. SB 57.
Notes: Amended by Ut. HB 336 (March 23, 2017) and by Ut. HB 24 (March 19, 2018)

HB 24/HB 76
Introduced: 12/2013
Sponsor: Rep. Dunnigan and Sen. Bramble; Rep. Bird and Sen. Harper
Status: Signed into law 1/2014
Summary: These bills had identical subsections relevant to parity. They changed the parity section of the state insurance law to require individual plans and small employer fully-insured plans to cover behavioral health services and comply with the Federal Parity Law.

SB 57
Introduced: 2/2014
Sponsor: Sen. Shiozawa and Rep. Dee
Status: Signed into law 3/2014
Summary: This bill added the section of the state insurance law about autism coverage. That section is summarized at the bottom of this page under “Utah Parity Law.”

2012

HB 29
Introduced: 12/20111
Sponsor: Rep. Dunnigan and Sen. Bramble
Status: Signed into law 3/2012
Summary: Among many other things, this bill made a very minor change to the parity section of the state insurance law regarding how much plans could charge small employers during the first year the small employer chooses to cover “catastrophic mental health coverage.” However, this is no longer relevant because this section of the insurance law was changed in 2014 so that all small employer fully-insured plans must now cover behavioral health services and comply with the Federal Parity Law.

HB 272
Introduced: 1/2012
Sponsor: Rep. Menlove and Sen. Bramble
Status: Signed into law 3/2012
Summary: This bill appropriated state money to cover autism services for children covered by Medicaid during the 2011-2012 fiscal year and during the 2012-2013 fiscal year. This bill also created the autism coverage pilot program for state employees.

2011

HB 14
Introduced: 12/2010
Sponsor: Rep. Dunnigan and Rep. Valentine
Status: Signed into law 3/2011
Summary: This bill changed the parity section of the state insurance law so that it did not expire on July 1, 2011 as it had be set to do.

SB 86
Introduced: 2/2011
Sponsor: Sen. Jenkins and Rep. Dee
Status: Signed into law 3/2011
Summary: Among other things, this bill changed the parity section of the state insurance law so that it did not expire on July 1, 2011 as it had be set to do.

HB 128
Introduced: 2/2011
Sponsor: Rep. Dunnigan and Rep. Valentine
Status: Signed into law 3/2011
Summary: Among many other things, this bill changed the parity section of the state insurance law so that small employer fully-insured plans could offer small employers plans that complied with the Federal Parity Law.

2010

HB 39
Introduced: 12/2009
Sponsor: Rep. Dunnigan and Sen. Niederhauser
Status: Signed into law 3/2010
Summary: This bill changed the parity section of the state insurance law so that large employer fully-insured plans must comply with the Federal Parity Law, if the plans covers behavioral health services.

2000

Primary Focus: Parity – General; Mandated Benefits
Title/Description: Catastrophic coverage of mental health conditions
Citation: Utah Code Ann. § 31A-22-625
Summary: Insurers may provide small and large employers the option to choose among a variety of different mental health plan coverage provisions. For instance, at the time of purchase and renewal, a small employer may choose between catastrophic mental health coverage, or federally qualified mental health coverage in compliance with the ACA; and 50/50 mental health coverage. That said, an insurer may offer small employers to provide coverage that excludes benefits for mental health conditions.
An insurer shall offer large employers mental health and substance use disorder benefit in compliance with the federal requirements.
Effective Date: March 16, 2000.
Notes: Amended by Ut. HB 35, April 1, 2014.

Utah Parity Law

There is one section of the state insurance law about behavioral health coverage and another section about autism coverage.

Behavioral Health Coverage

This section of the insurance law is about behavioral health coverage. Large employer fully-insured plans must offer optional behavioral health coverage that complies with the Federal Parity Law. Individual plans must cover behavioral health services and that coverage must comply with the Federal Parity Law.

There is contradictory language in this section about small employer fully-insured plans. A subsection of the law was added in 2014 that requires small employer fully-insured plans to cover behavioral health services and comply with the Federal Parity Law. Older subsections of the law do not require these plans to provide coverage for behavioral health services that complies with the Federal Parity Law. It is the opinion of ParityTrack that these older subsections are no longer relevant and they will not be summarized here. If you know or believe otherwise, please contact us at info@paritytrack.org.

Autism Coverage

Beginning on January 1, 2016 this section of the law requires individual plans and large employer fully-insured plans to cover autism services for children age 2 through age 9.

Plans must cover 600 hours per year of “behavioral health treatment”, which includes applied behavior analysis.

Deductibles, copayments, coinsurance, and annual limits must be the same for autism services as what are in place for other medical coverage.

Insurance plans can only review a child’s treatment plan once every 6 months.

Autism spectrum disorder is defined as “pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).”

Autism treatment is defined as:

Plans can be exempted from complying with section of the law if they can demonstrate that premium costs rose by at least 1% because of complying with this section.

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Utah Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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