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)
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.”
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.
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.
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.
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 firstname.lastname@example.org.
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