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.