Senator proposes widening autism-diagnosis authority to some master’s-level clinicians; committee hears concerns about market impacts

Senator Kwan presented a proposal (referred to in the hearing as “sub 2”) to allow specified master’s-level therapists who hold listed licenses, standardized training and certification to diagnose autism for insurance purposes. The sponsor said the change restores scope that existed in practice before insurance coverage patterns narrowed diagnostic coverage to doctoral-level clinicians starting around 2012 and said the goal is to reduce wait times for diagnosis, which witnesses described as ranging from about one month to as long as 18 months depending on provider and payer.

Supporters included behavioral-health organizations and therapists who said there are currently fewer than two dozen master’s-level providers statewide who are certified to perform autism diagnostic assessments and that adding them would reduce backlog without changing standards because the diagnostic instrument and certification are standardized.

Opponents or cautious stakeholders — including the Utah Health Insurance Association — raised concerns that expanding the pool of diagnosticians would increase the number of covered diagnoses in the small-group market the state can regulate, and that small employers could bear higher costs. Committee members asked how federal reimbursement proposals (cited as SB 256 in testimony) would interact; sponsors said they included a contingency clause tying implementation to complementary legislation intended to mitigate fiscal impacts. Representative Thurston confirmed the bill would require insurers in regulated markets to accept diagnoses from the newly authorized providers, which would expand the number of covered patients and affect both the individual and small-group markets absent federal reimbursement changes.

No final vote on this bill was taken during the hearing; committee members moved to the next agenda item before further action.