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H.B. 186

             1     

HEALTH INSURERS - REFERRAL TO

             2     
SPECIALIST PROCESS

             3     
2000 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Sponsor: Mary Carlson

             6      AN ACT RELATING TO INSURANCE; REQUIRING AN INSURER TO ESTABLISH A
             7      PROCESS FOR STANDING REFERRALS TO HEALTH CARE SPECIALISTS; AND
             8      PROVIDING AN EFFECTIVE DATE.
             9      This act affects sections of Utah Code Annotated 1953 as follows:
             10      ENACTS:
             11          31A-22-625, Utah Code Annotated 1953
             12      Be it enacted by the Legislature of the state of Utah:
             13          Section 1. Section 31A-22-625 is enacted to read:
             14          31A-22-625. Standing referral to a specialist.
             15          (1) With respect to a health insurance policy or health maintenance organization contract
             16      that does not allow an insured to have direct access to a health care specialist, the insurer shall
             17      establish and implement a procedure by which an insured may obtain a standing referral to a health
             18      care specialist.
             19          (2) The procedure established under Subsection (1):
             20          (a) shall provide for a standing referral to a specialist if the insured's primary care provider
             21      determines, in consultation with the specialist, that the insured needs continuing care from the
             22      specialist; and
             23          (b) may require the insurer's approval of a treatment plan designed by the specialist, in
             24      consultation with the primary care provider and the insured, which may include:
             25          (i) a limit on the number of visits to the specialist;
             26          (ii) a time limit on the duration of the referral; and
             27          (iii) mandatory updates on the insured's condition.


             28          Section 2. Effective date.
             29          This act takes effect on July 1, 2000.




Legislative Review Note
    as of 11-1-99 7:36 AM


A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel


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