SB 175: Health Insurance Revisions - Utah

Substitute #1 → Substitute #2 · 5 edits

MODERATE

The bill was revised to remove broad autism insurance mandates and replace them with a narrower focus on defining terms and creating a reporting requirement. The previous version required health plans to cover autism treatments and set specific coverage limits, while the new version simplifies the statute to clarify definitions and establish a mechanism for reporting data.

Scope change

The bill's scope was significantly narrowed; it no longer mandates specific coverage levels or treatment hours for autism spectrum disorder in health benefit plans.

REQUIREMENT

Removed mandates requiring health benefit plans to cover autism spectrum disorder diagnosis and treatment, including specific hour limits for behavioral health treatment.

Added a new requirement for the commissioner to adopt rules establishing a reporting mechanism, replacing the previous rules regarding minimum coverage standards.

ELIGIBILITY

Eliminated provisions that required plans to provide autism coverage for children aged two to ten and removed references to preexisting condition mandates.

DEFINITION

Reorganized and simplified the definitions section, removing the detailed list of covered services (such as pharmacy, psychiatric, and therapeutic care) previously included in the statute.

TIMELINE

Changed the effective date of the bill from January 1, 2027, to an unspecified date in the substitute text, though the header indicates a 2026 session.

Amended 2/24/2026 11:02:510 → Substitute #1 · 5 edits

MODERATE

This bill replaces the previous version of SB 175 to broaden autism insurance coverage by allowing more types of healthcare providers to diagnose the condition and by integrating autism treatment into the state's medical benefit benchmarking requirements. It also updates the repeal schedule for related reporting mandates and clarifies definitions to align with current medical standards.

Scope change

The bill's scope expanded to include a broader range of licensed professionals (such as clinical social workers and marriage and family therapists) who can diagnose autism, whereas the previous version restricted diagnosis primarily to physicians and psychologists.

ELIGIBILITY

Expanded the list of qualified healthcare providers who can diagnose autism spectrum disorder to include clinical social workers, marriage and family therapists, and clinical mental health counselors, in addition to physicians and psychologists.

REQUIREMENT

Added a requirement for the state department to exclude autism treatment from the commercial health benefit benchmark if the benchmark does not already cover it, ensuring autism care is not penalized in rate-setting calculations.

DEFINITION

Updated definitions of autism diagnosis and treatment to rely on 'qualified health care providers' rather than restricting diagnosis to specific physician specialties, and clarified that diagnosis must be generally accepted within the medical and mental health professions.

TIMELINE

Changed the repeal date for the autism coverage reporting requirement from January 1, 2030, to July 1, 2029, and adjusted the repeal date for ground ambulance reimbursement from July 1, 2027, to July 1, 2029.

TECHNICAL

Corrected the list of Utah Code sections affected to include 26B-3-904 (Program benefits) and removed references to repealed sections (63I-1-231) that no longer exist in the current code structure.

Amended Excerpts 2/24/2026 11:02:510 → Amended 2/24/2026 11:02:510 · 3 edits

MINOR

The bill was reformatted from a draft amendment document into a formal legislative substitute bill with a new title and official sponsor information. The substantive policy content regarding autism insurance definitions and coverage requirements remains largely unchanged, though the text was cleaned up to remove conflicting markup symbols and consolidate the definitions into a single, coherent section.

TECHNICAL

The document structure was changed from a raw amendment diff to a formal bill format, including the addition of a title page, general description, and official sponsor names.

Conflicting markup symbols (such as arrows and brackets) were removed and the text was consolidated to present a clean, final version of the definitions for autism spectrum disorder treatment.

Line numbers and page headers were updated to reflect the new formal bill structure rather than the original amendment excerpts.

Enrolled → Amended Excerpts 2/24/2026 11:02:510 · 2 edits

MINOR

The bill amends autism insurance coverage definitions to include a broader range of healthcare providers, such as clinical social workers and physician assistants, who can diagnose and treat autism. It also updates reporting requirements to track reimbursement for these newly included provider types.

Scope change

The scope of eligible providers for autism diagnosis and treatment was expanded to include advanced practice nurses, clinical social workers, marriage and family therapists, clinical mental health counselors, and physician assistants.

DEFINITION

The definition of 'Mental health therapist' was replaced with a new definition for 'Qualified health care provider' that explicitly lists physicians, osteopathic physicians, advanced practice nurses, clinical social workers, marriage and family therapists, clinical mental health counselors, psychologists, and physician assistants as eligible to diagnose autism.

REQUIREMENT

The reporting requirement for health benefit plans was updated to include information on whether plans reimburse 'qualified health care providers' (as defined above) who are not physicians or psychologists for autism treatment.

Introduced → Enrolled · 4 edits · Mar 18, 2026

MODERATE

This bill simplifies the text of Utah's autism insurance coverage law by removing outdated references to a separate medical benefits section and reorganizing the definitions. The primary substantive change is the addition of a new reporting requirement, replacing the previous mandate that allowed health plans to exclude autism coverage from their benchmarking calculations. The bill also updates the list of affected code sections to reflect recent legislative changes.

Scope change

The bill's scope remains focused on autism insurance coverage, but the applicability of the benchmarking rule has changed by removing the ability for plans to exclude autism coverage from those benchmarks.

REQUIREMENT

Removed the requirement for health benefit plans to exclude autism coverage from the benchmark used to determine minimum medical benefits.

Added a new requirement for health benefit plans to submit a report regarding autism coverage.

TECHNICAL

Updated the list of Utah Code sections affected to remove references to 26B-3-904 and add references to 63I-1-231.

DEFINITION

Reorganized and clarified the definitions of various care types, adding a definition for 'mental health therapist' and adjusting the structure of other terms.

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