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H.B. 186 Enrolled

                 

HEALTH INSURERS - REFERRAL TO SPECIALIST PROCESS

                 
2000 GENERAL SESSION

                 
STATE OF UTAH

                 
Sponsor: Mary Carlson

                  AN ACT RELATING TO INSURANCE; REQUIRING AN INSURER TO ESTABLISH A
                  PROCESS FOR STANDING REFERRALS TO HEALTH CARE SPECIALISTS; AND
                  PROVIDING AN EFFECTIVE DATE.
                  This act affects sections of Utah Code Annotated 1953 as follows:
                  ENACTS:
                      31A-22-625, Utah Code Annotated 1953
                  Be it enacted by the Legislature of the state of Utah:
                      Section 1. Section 31A-22-625 is enacted to read:
                      31A-22-625. Standing referral to a specialist.
                      (1) With respect to a health insurance policy or health maintenance organization contract
                  that does not allow an insured to have direct access to a health care specialist, the insurer shall
                  establish and implement a procedure by which an insured may obtain a standing referral to a health
                  care specialist.
                      (2) The procedure established under Subsection (1):
                      (a) shall provide for a standing referral to a specialist if the insured's primary care provider
                  determines, in consultation with the specialist, that the insured needs continuing care from the
                  specialist; and
                      (b) may require the insurer's approval of a treatment plan designed by the specialist, in
                  consultation with the primary care provider and the insured, which may include:
                      (i) a limit on the number of visits to the specialist;
                      (ii) a time limit on the duration of the referral; and
                      (iii) mandatory updates on the insured's condition.
                      Section 2. Effective date.
                      This act takes effect on July 1, 2000.
                 


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