DAR File No. 37809

Health, Family Health and Preparedness, Children with Special Health Care Needs

Rule R398-15

Autism Treatment Account

Notice of Proposed Rule

(Amendment)

DAR File No.: 37809
Filed: 07/01/2013 11:47:02 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify legislative intent to implement the Autism Treatment Account.

Summary of the rule or change:

This rule change modifies the age of qualification for services from "younger than six" to "younger than seven". This change, therefore, extends eligibility for services through six years of age.

State statutory or constitutional authorization for this rule:

• Section 26-52-201

Anticipated cost or savings to:

the state budget:

No change--Costs include staff time to administer the account and volunteer time from committee members to serve an advisory role, develop application process and review applications from treatment providers, and monitor reports from providers.

local governments:

No change--Funds will be disbursed through treatment providers to eligible children.

small businesses:

No change--Cost: Time for providers to prepare applications to receive funds to treat eligible children. As this is a new program, the Department does not have records to indicate cost burden or savings.

persons other than small businesses, businesses, or local governmental entities:

Children receiving therapy may extend services up to age seven. Cost to families: Time to identify contracted providers and enroll children for treatment. Savings to families: Treatment will be provided free to families up to the full amount appropriated. The Department has estimated approximately 30 children will receive services through the current amount appropriated.

Compliance costs for affected persons:

No change--Current providers will continue to offer services to children but will now be able to extend those services to children up to age seven. Cost to providers and families: time to complete application processes involved.

Comments by the department head on the fiscal impact the rule may have on businesses:

No effect on businesses--More individuals will be eligible to receive services so there will be more opportunity for provider reimbursement.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Family Health and Preparedness, Children with Special Health Care Needs
44 N MARIO CAPECCHI DR
SALT LAKE CITY, UT 84113

Direct questions regarding this rule to:

• Rebecca Giles at the above address, by phone at 801-538-6259, by FAX at , or by Internet E-mail at rgiles@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/14/2013

This rule may become effective on:

08/21/2013

Authorized by:

David Patton, Executive Director

R398. Health, Family Health and Preparedness, Children with Special Health Care Needs.

R398-15. Autism Treatment Account.

R398-15-1. Purpose and Authority.

The purpose of this rule is to identify criteria and procedures for selecting children who may qualify for assistance from the account and identify qualifications, criteria, and procedures for selecting service and treatment providers that receive disbursements from the Autism Treatment Restricted Account.

This rule is authorized by Section 26-52-202(4) which provide that the Autism Treatment Account Advisory Committee, hereafter known as the "Committee", may make rules governing the Committee's activities.

 

R398-15-2. Qualification Criteria and Procedures for Selecting Children Who May Qualify for Assistance from the Account.

(1) Qualification Criteria

a. Child who is at least two but younger than [six]seven years of age upon enrollment,

b. Resident of Utah,

c. Diagnosed by a qualified professional as having an autism spectrum disorder, and

d. Have a need that can be met within the requirements of UCA 26-52,

i. Must need and be able to receive a minimum of six months of applied behavior analysis (ABA) therapy, and

ii. Cannot be receiving formal ABA therapy services from other state funded sources under this law (Medicaid Waiver or PEHP) or ABA therapy for a minimum of 20 hours per week covered at 80 percent or more of cost of treatment by other insurance while receiving services funded through this account.

(2) Procedures for selecting children

a. Providers selected through the request for application (RFA) process are responsible for enrollment and determining if a child meets qualification criteria utilizing UDOH enrollment forms for children

b. If applications for enrollment of children exceeds capacity of this funding, providers shall select children using a random process

 

R398-15-3. Qualifications, Criteria and Procedures for Evaluating Service and Treatment Providers to Include in the Program.

(1) Providers are qualified to receive funds if:

a. They utilize ABA for treatment alone or in conjunction with other proven effective treatments as outlined in an RFA process;

b. Treatment is provided by or supervised by a board certified behavior analyst or licensed psychologist with equivalent university training and supervised experience who is working toward board certification in ABA;

c. They are willing to collaborate with existing telehealth networks to reach children in rural and underserved areas of the state;

d. They utilize methods to engage family members in the treatment process; and

e. They agree to serve and treat only eligible children with this funding.

(2) Procedures for evaluating providers

a. Funding requests to the Committee from providers will be made on a standard RFA which will be developed and authorized by the Committee and made available by the Department

b. Providers that meet the minimum requirements in Subsection 3.1., will be evaluated for funding by a review committee.

c. Criteria used to select providers for funding will include:

i. Per eligible child cost for treatment proposed by provider;

ii. Provider or organization's background and qualifications;

iii. Description of treatment and services to be provided;

iv. Additional consideration will be given to those with existing connections to telehealth or evidence of written policies and procedures for providing ABA services via telehealth; and

v. Additional consideration will be given to those who show evidence of providing services in rural and underserved communities.

(3) Funded providers will submit required reports as outlined in the RFA to UDOH/Committee on use of funds, two of which shall include:

a. Detailed description of how provider will report evaluation of benefits and outcomes for children receiving services; and

b. Monthly invoice and justification of expenditures consistent with uses as specified in UCA 26-52.

(4) RFAs will be authorized contingent on funds available.

 

R398-15-4. Conflict of Interest within the Advisory Committee.

(1) Committee members will sign a conflict of interest form identifying affiliations with providers that apply for funding from the Autism Treatment Account, and/or known family members that may receive treatment or evaluation services directly funded through the Autism Treatment Account from a provider that has submitted an application for funding. The conflict of interest form will be signed prior to review of funding requests.

(2) If an issue is to be decided by the Advisory Committee that involves potential conflict of interest with a member of the committee, it is the responsibility of the member to:

a. Identify the potential conflict of interest.

b. Not participate in discussion of the program or motion being considered.

c. Not vote on the issue.

(3) It is the responsibility of the Committee to:

a. Award funds based on quality of application regardless of committee affiliation.

b. Record in the minutes of the Advisory Committee Meeting the potential conflict of interest, and the use of the procedures and criteria of this policy.

 

KEY: autism treatment, applied behavior analysis (ABA), autism spectrum disorders

Date of Enactment or Last Substantive Amendment: [July 31, 2012]2013

Authorizing, and Implemented or Interpreted Law: 26-52-201; 26-52-202