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H.B. 186
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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.