S.B. 175 Health Insurance Revisions: transcript

We thank you Mr. Chair. I do, uh, have sub two that I would like to, um, I would like to, uh, pass.

Um, thank, thank you Mr. Chair. I make the motion that we delete, embody and title SB 1 75 and, um, substitute that with second substitute SB 1 75.

It's only a 20 minute presentation that, well, there we Go. It'll work out. Just teasing, just teasing. Um, and thank you Mr. Chair for accommodating my schedule this morning. Um, so this is a, uh, bill that we've been working on for a couple of years because of, uh, two main issues. Uh, first of all, it's the wait list, uh, for getting, um, our, our kids diagnosed. Uh, when they're suspected of having, um, being, uh, let's see, what is the, the phrase, it's not having autism, it's being on the spectrum. That's correct. Okay. And, uh, we've had some really, uh, a difference of numbers in terms of the wait list. Um, uh, some reports that say that it can be as short as seven days, uh, to upwards of 18 months depending on where you're going. And what, what we are hearing from parents and families and practitioners is that, uh, first of all, we know that the earlier you diagnose, the better off the outcomes are, and it's less expensive. Secondly, the earlier you diagnose, um, uh, oh, sorry, uh, that families who are waiting for diagnosis, sometimes we'll go and get a diagnosis from a master's level therapist because it is, um, it is within their scope. So they're allowed to do this, and then when they go and get treatment or the, uh, clinician, uh, goes to get reimbursed, they may not get reimbursed. And we have had stories of families, uh, getting a, uh, diagnosis from a master's level therapist and then going to get treatment, but that treatment is not covered because it was not diagnosed by a physician as per our insurance law. So they then they've had to, uh, go and get another diagnosis, and this can cost thousands and thousands of dollars. So this is a, a huge cost, uh, for our, um, for our families. Now, uh, as I had said, within Doppel, uh, master's level therapists do have the scope, um, with licensed training and expertise. Uh, this is the scope to diagnose, and they've always had the scope to, um, to treat, but the statute is confusing, and so some therapists will self-select out. That is, they won't diagnose, some will, uh, diagnose and then, uh, get denied for reimbursement. Um, and then, uh, there, there are others actually who are getting reimbursed. And we found this out by the all payers claim database. So this bill, um, has gone around the block, uh, a number of times, and what we have, uh, landed on is, uh, let me get back to my bill in order to address the issue of the wait list disparities and not knowing what is out there in the landscape. We've included, and you'll see on lines 1 26, uh, through, uh, 1 42. This is a study or a report that we are asking, um, insurance, uh, uh, companies to, uh, give, uh, based on, um, types of treatment that is, uh, a BA, because we know how expensive A BA is. Uh, we're asking for, um, uh, how many, um, uh, enrollees under age 18, uh, were diagnosed, uh, with autism spectrum. Uh, we're asking for, um, uh, the number of hours applied to, uh, behavior analysis treatment. And we're doing this sort of see what is the landscape again, because it's, we are getting such, uh, confusing and, and disparate, uh, information. Uh, in order to address the issue of our, uh, licensed, um, master's level therapists, again, who do have the scope and the, those that have the expertise and training, uh, to do the, the job that they, uh, are, have under our, uh, DOPPEL code, uh, to be able to do, to understand the landscape of the, who is cover, uh, reimbursing for, uh, diagnosis. Um, part of that report will be an ask, uh, to insurance agencies whether or not they reimburse, uh, or actually what types of licenses do they reimburse, uh, autism diagnosis for. And that will be on a website as well as a, uh, a report to, uh, the interim, uh, HHS. Um, and I'm, I'm gonna stop there. Um, Mr. Chair, I do have Sarah Strub here for, uh, if there are any questions, um, on specifics, but

I'll go first if that's okay, since I'm already here. Uh, Sarah STR with the Utah Association for Marriage and Family Therapy, um, also a licensed marriage and family therapist and a registered play therapist. Uh, we are in strong support of this bill and applaud Senator wan's efforts to bring attention to this important issue. Currently, Utah families are trapped in a diagnostic bottleneck where inconsistent waste wait list estimates and, um, an unnecessarily narrow list of authorized providers create a data blackout for the state. This lack of transparency often pushes parents towards a single specific treatment path and causes immense frustration as a struggle to determine which provider's insurance will actually reimburse for assessment, diagnosis, and treatment. The data collection enabled by this bill is essential for the development of smarter data-driven state policy, creating a vital feedback loop that allows the state to measure outcomes and refine mandates based on what actually works for Utah children. This bill replaces a rigid, confusing system, and we urge your support. Thank you.

Hello? Um, I'm ressa long and I'm showing support for Senate Bill 1 75. One thing that stands out from our experience with an autism diagnosis and treatment is how confusing and directionless it felt after our child was diagnosed. I wanted someone to sit down with me and explain a treatment plan and likely steps, next steps. That never happened. So every, uh, decision felt like a shot in the dark. Insurance added another layer of stress. We didn't know what would be covered, which providers accepted our plan or how much treatment would cost. The 15 hour minimum requirement for a BA services felt overwhelming and not like something that my child needed. Um, not just in time, but in cost. And we struggled to find alternatives because options were unlimited or were limited and unclear. There's also a kind of grief that comes with both the diagnosis and financial barriers to treatment. You let go of the future you expected for your child, and then because care can be so costly or hard to access, you end up saying no to things that might help. That carries guilt, no parent should have to carry.

Hello, my name is Kirsten Jacobson, and I'm a resident of Senate District seven. I'm here to share the battle we face, trying to get the diagnosis for my neurodivergent daughter, Jill Lee and I can back that we did in fact spend thousands and thousands of dollars trying to get the diagnosis and treatment for her. We first noticed her developmental delays when she was 15 months and began the path, um, being referred to baby watch and early intervention where we received supported services, but not a diagnosis. It wasn't until kindergarten that everything screeched to a halt when we tried to get the diagnosis and we were told she's so young, wait and see, start getting on wait lists. It took us a full 12 months to get diagnosis for her while she continued to fall further and further and further behind. She was one of the third graders that struggles with literacy. Currently because of the lack of diagnosis, no child should struggle for a year simply to wait to be seen. Timely. Diagnosis is a doorway to support, learning, and hope for our children. So please support these policies to expand access to the diagnostic services for our neurodivergent children. Thank you. Thank you.

Thank you members, Mr. Chairman, members of the committee. My name is Brian Allen. I represent America's health insurance plans or otherwise known as ahip. We are opposed to this bill, as in its current form. Um, uh, we are very concerned about whether or not the people making diagnosis on these issues are properly trained and properly certified. Uh, we have, uh, real concerned about that. Um, additionally, um, you know, just from my own personal experience I had, I, uh, you know, I had a sister and a brother-in-law who passed away from an opiate overdose, so thank you Senator Plumb for your help on that effort. Um, but I inherited a, a 15-year-old boy that had autism. Well, we didn't know what he had. He'd been diagnosed, misdiagnosed as a young child and was mistreated for 15 years. And when I inherited it, I had to spend hundreds of thousands of dollars to unwind his problem. And I'm very, very concerned about misdiagnosis or, or, or a misdiagnosis. And we need to make sure that whoever's doing this is trained. We support the study part of the bill. We think that's the place to start, and I would love that to be the bill and, uh, go from there. Thank you. Thank you.

Thank you, Mr. Chairman. Michelle MCC with the Utah Medical Association. We also oppose the bill. We're concerned with expanding. Who can diagnose? Um, right now the mental health counselors can assess and test diagnosis different from assessed. Diagnosis is identifies the root cause. Assess focuses on gathering information to help after diagnosis. And so we're concerned with that expansion. There are childhood illnesses, genetic disorders, and neuro developmental conditions that can present with behavioral behavior, social, or communication Challenges that mask as autism spectrum disorder. Common mimics include A-A-D-H-D-O-C-D, severe social anxiety, language delays, intellectual disabilities, genetic conditions like Fragile X or RET syndrome. Thank you.

Thank you. Alright, good morning. My name is Jessica Black and I am the legislative chair for the Utah Mental Health Counselors Association. And I am here to speak in strong support of SB 1 75. Um, I often see the exhausting second job that parents take on when they are trying to get a diagnosis or treatment for their child. Um, we are seeing a very concerning rise in fraud for a BA services across the nation recently, um, led Idaho Medicaid to stop paying for a BA services altogether. So the section of this bill, uh, requiring some of the data collection is to hopefully prevent any similar issues happening here in Utah because there are children that need a BA therapy. Um, this is not a scope of practice discussion. It's already been, um, shown that it is in our scope of practice. I, myself have years of training and experience in, um, diagnosing autism. Uh, the average wait times are going to be addressed with this bill so that we can actually see what the landscape looks like. Also, it requires provider transparency and publicly sharing which plans reimbursed qualified providers. I encourage you to support this bill.

Uh, thank you Mr. Um, chair, make a motion that we pass favorably SB 1 75. I know this, um, Senator Juab has been working on this and is always willing to, um, get where people can meet and the stakeholders. So I trust her that she can navigate that as we move towards, uh, the Senate floor. Thank you, Mr. Chair.

Oh, thank you. I I jumped the gun there. I apologize. Um, I wanted to clarify that sub two takes everything out except for the study. So the part about diagnosing, expanding, diagnosing, um, all of the questions about that is, uh, is it's another, it's a discussion for another day. Um, and in fact, I just spoke with, um, Michelle McCumber of, um, UMA and, uh, she, she said that she was speaking to an earlier sub and that she supports this sub. Is that right? Just wanna make sure. Hang on.

Okay. So I, I, I believe that that'll take care of the, um, uh, the disagreements with this, the opposition to this bill. None of that is in this bill. Again, it is only the re the study.

So move to the motion for approve the minutes of February 3rd, please.

Thank you. Mr. Chair.

S sp 1 75 second substitute, correct?

Thank you, Mr. Chair. So this is, um, for the last couple of years, and I know that this committee saw this bill last year as well. I've been working on two issues within the autism diagnosis space. The first one is the master's level therapist who have the scope training and expertise to diagnose autism, but they're not always consistently getting reimbursed by insurance. Um, and the second thing is the long wait list, which actually also is in dispute. Um, meaning we don't really know how long that wait list. Um, it could be as short as a few weeks to as long as several months, like over a year. Um, so what we came to in this second sub is a consensus bill, um, that, uh, proposes a study to seek clarification on these issues. And some of these issues are the wait lists, um, for autism diagnosis, the type of provider license that are currently diagnosing, uh, autism and getting reimbursed by a health benefit plan. The average number of hours and the average costs of applied behavior, uh, analysis, that's a BA treatment and which health bene benefit plans accept state de frail payments. We also, um, we'll have these re uh, be reported to HHS, um, but it will also be reported on the, um, state insurance website so that it's more easy for our master's level therapist to find out which health plans are reimbursing. Um, and then this report will, um, Sunset in three years. And that concludes my presentation, Mr. Chair.

Questions? Questions? Clarifying questions? Um, I forgot, Huh? I forgot.

Thank you, Mr. Chair. I, I would just like to, to see this report as well. That's going to HHSI think that'd be very enlightening where we we're hearing this bill now. And just if you could bring that report here as well, I think that would, that would shed a lot of light on this.

Thanks, Mr. Chair. Uh, super small fiscal note, senator. Um, and you're looking just essentially for a study? Yes. Okay. And I think that's perfectly necessary in this case. I know a lot of families in this position, so thank you. Thank you. Thanks, chair.

Thank You. Thank you, Mr. Chair, members of the committee. Um, I know I promised I wouldn't say anything, but Senator Kwan asked me to please do so. So I just wanted to to, to thank her for her gracious work on this. Um, She's she's gonna owe us then I'll, It, it's, it's, it, it started in a place we had some concern with. She was, we've got it into a place. We,

I represent ahip, Um, I'm sorry, say it again. I Represent AHIP America's Health Insurance plans. Okay. So we are very supportive of the bill. We think the study's gonna be super helpful for us to determine how to better, uh, panel providers and to better serve the needs of our, uh, policy holders. So we're very much in favor of the bill. Thank you.

Hello, my name is Sarah Strub. I'm a licensed marriage and family therapist and the legislative chair for the Utah Association for Marriage and Family Therapy. We are in strong support of this bill and applaud the bill sponsor's efforts to bring attention to the support important issue. Currently Utah families are trapped in a diagnostic bottleneck where inconsistent wait list estimates and unnecessarily narrow list of authorized providers created data blackout for the state. The data collection enabled by this bill is essential for the development of smarter data-driven state policy, creating a vital feedback loop that allows the state to measure outcomes and refined mandates based on what actually works for Utah children. Uh, we urge your support on this bill.

All right. Good afternoon, chairman and members of the committee. My name is Jessica Black and I'm the legislative chair for the Utah Mental Health Counselors Association. And I am here today.

Okay. How's that? Can you see me now?

Okay. Okay. Um, in my practice, do you want me to introduce myself again or could you hear me?

Okay. Thank you. I am Jessica Black. I'm the legislative chair for the Utah Mental Health Counselors Association. Um, and I'm here to speak in strong support of this bill. Um, in my private practice, I see parents forced into this second job just to navigate insurance hurdles and massive wait lists, um, to get their child some life changing treatment, um, or diagnosis. And nationally, there is rising fraud in a BA care. Recently, it has led Idaho Medicaid to stop payments entirely. Um, this would be devastating for the state of Utah. And so by mandating this robust data collection on wait times, treatment costs, and provider reimbursement, hopefully we can prevent that from happening here. Um, data is the foundation of accountability, and without it, we cannot address these barriers that families are facing, um, and ensure that insurance companies are providing clear data as well. So I really, uh, strongly urge you to support this bill. Thank you.

Thank you, Mr. Chair. I move that we favorably recommend SB 1 75 health insurance revisions.

Oh, yes. Thank you. I, I, uh, appreciate this, this, um, issue and this bill has gone around the block the last few years and I'm so glad we've gotten to consensus.

Um, I appreciate the Senator Vickers Good work on this. Um, I know my family's had issues on this, trying to find some testing and some resources. So I think this is a great, great option. Thank you for doing this study.

Thank you. I would like to move that we place this on the consent calendar. Uh, I'm sorry.

Mr. President, um, uh, with SB 1 75, I actually have an amendment, um, and I'd like to move amendment one in my name and then speak to that,

So the amendment brings the bill into consensus with all stakeholders and it takes out all the disputed, uh, definitions, but keeps in the study, uh, that uh, everybody agrees. All the stakeholders agree that is needed.

You Mr. President. For the last couple of years I've been looking at the issue of master's level therapists who have the scope training ex and expertise to diagnose autism. Um, but then they're not necessarily being reimbursed by insurance. Um, and then a second, uh, issue is a long waiting list, which I had thought that the master's level therapist diagnosing would help, uh, with that long waiting list. But both of these issues are, um, really fraught with disagreement and it has become a, a bigger question, uh, than originally thought. And so what this study does is seeks clarification. Um, and we all agree again. Uh, the, there's consensus on this study. So some of the issues that this, uh, study will, um, look at is the wait list for autism diagnosis, the type of provider licenses that are currently diagnosing autism and getting reimbursed by a health benefit plan. The average number of hours and average costs of a BA, which has applied behavior analysis treatment and which health plans, sorry, which health benefit plans accept state derail payments. Um, and uh, this is will, uh, Sunset in three years. Uh, so with that, I Thank you. Will take any questions. Thank you.

Thank you. I waive, uh, summation and call a question. Thank

surrounds the question of diagnosis of autism. That concludes my presentation

I waive summation and, uh, move that second sub SB 1 75 pass.

Senator Vickers Baldry Aye. Lewin Aye. Brammer. Aye. Gu Comore Escamilla Aye. Fillmore Aye. Grover Harper Kins Ipson Johnson. Juab Aye. McKay Mikel Milner Musselman Owens Pitcher Aye. Plum Rebi Aye. Sandal Stevenson Stratton Vickers Weiler Aye. Wilson Winterton, president Adams

Your speaker, I am very pleased to be ready to present this consent bill. Uh, this is a consensus bill that is, uh, proposed us to do a study to clarify several points of confusion that have to do with who can provide autism, autism diagnosis services and get reimbursed. There's a lot of confusion in the, um, industry about who can do it and whether they get paid and how they get paid. So rather than try to clarify all of that with no information, the bill simply asks that there be a study done of this and that the insurance department then publish on their website the results of that study so that both the insurance companies and the master's level therapists know what are the rules of engagement when it comes to providing this service and getting reimbursed. So it's, it's a study that is helpful to those and it makes it information to everybody so everybody knows what's going on in the industry. So with that, I would encourage your support, Mr. Speaker.