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Utah House approves bill requiring insurers to cover autism treatments after extended debate
Summary
The House passed SB 57, requiring insurers to cover medically necessary autism treatments and embedding safeguards including a 1% premium opt-out for employers and periodic effectiveness reviews; sponsors cited high state prevalence and evidence supporting early intervention.
The Utah House of Representatives voted to pass first substitute Senate Bill 57 on March 12, 2014, a measure requiring insurers to cover medically necessary treatments for children with autism spectrum disorders. Floor sponsor Representative Dee said the bill reflects broad stakeholder negotiation and aims to expand access to early intervention services in a state the sponsors described as having one of the highest autism prevalence rates in the country.
Supporters emphasized evidence that early intervention improves long-term outcomes and can reduce later public costs. Representative Dee told colleagues that about 18,000 Utah children are affected and framed the measure as a cost-effective, evidence-based intervention. Representative Sompe, who disclosed employment ties to Intermountain Healthcare, described negotiated provisions to limit unintended cost-shifting to employers, including a 1% opt-out mechanism by which employers could decline if premiums rose beyond a 1% threshold.
Debate also focused on definitions and federal compliance. Representatives noted the bill contains agreed definitions of qualifying treatments and requires regular assessments of treatment effectiveness. Representative Sompe highlighted embedded language that would permit caps in the bill to be waived if the attorney general determines they are unenforceable under federal behavioral health parity laws (the Affordable Care Act). Representative Wilson warned members the fiscal note shows future-year costs beginning in 2016 and said passage represents a budgetary commitment that extends beyond the current budget cycle.
Several members framed the vote as a long-sought step by advocates and families. Representative Cunningham noted personal ties through his wife's work with affected students and said the bill is overdue; Representative Duckworth recounted family experience with autism to underline the bill’s importance. Opponents raised procedural and cost concerns, but multiple speakers credited extensive stakeholder negotiation that produced the current compromise.
Final passage was recorded at 69 yes to 3 no. The bill will be returned to the Senate for further consideration. Next steps identified on the floor included implementation planning by insurers and periodic reviews of treatment effectiveness as specified in the bill's language.
