DAR File No. 40402

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

Rule R398-15

Autism Treatment Account

Notice of Proposed Rule

(Repeal)

DAR File No.: 40402
Filed: 05/03/2016 04:49:15 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The statute (Title 26, Chapter 52) that authorizes the rule was repealed in S.B. 50 during the 2016 General Session.

Summary of the rule or change:

This rule is repealed in its entirety.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 52

Anticipated cost or savings to:

the state budget:

The Division may incur minimal cost of approximately $50 to delete and repeal the rule out of publications. The proposed repeal does not have costs affiliated with it. The deletion of the rule cuts costs for the Division. The left over funds from the Autism Treatment Account (ATA) transferred to the Medicaid plan increases funds available for the autism spectrum disorder patients.

local governments:

No funding was provided to local government and therefore none will be affected by this repeal.

small businesses:

Contracts to four small businesses from the Autism Treatment Account expired June 2014. No further impact on small businesses will be experienced.

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

Contracts to provide services to children with autism expired in June 2014. No further services have been provided since that date. No further impact will be experienced.

Compliance costs for affected persons:

No funding has been appropriated since fiscal year 2014. There are no ongoing programs or compliance cost associated with the Autism Treatment Account.

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

There may be fiscal impact on business in that any funds remaining in the ATA are to be deposited into the state Medicaid plan and used for the autism spectrum disorder program including payment for services from Medicaid providers.

Joseph Miner, MD, 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:

• Joyce McStotts at the above address, by phone at 801-584-8239, by FAX at 801-584-8488, or by Internet E-mail at [email protected]

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:

07/01/2016

This rule may become effective on:

07/13/2016

Authorized by:

Joseph Miner, 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 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: August 27, 2013

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