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7 LONG TITLE
8 General Description:
9 This bill addresses insurance coverage of behavioral health services.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms; and
13 ▸ subject to exceptions, requires certain health benefit plans to:
14 • upon request of an enrollee who is a health care provider, offer a single case
15 agreement for covered behavioral health treatment; and
16 • include certain terms in the single case agreement.
17 Money Appropriated in this Bill:
18 None
19 Other Special Clauses:
20 None
21 Utah Code Sections Affected:
22 ENACTS:
23 31A-22-657, Utah Code Annotated 1953
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25 Be it enacted by the Legislature of the state of Utah:
26 Section 1. Section 31A-22-657 is enacted to read:
27 31A-22-657. Single case agreement -- Treatment of a mental health condition for a
28 health care provider.
29 (1) As used in this section:
30 (a) "Mental health condition" means the same as that term is defined in Section
31 31A-22-649.5.
32 (b) "Mental health provider" means:
33 (i) a mental health therapist, as defined in Section 58-60-102; or
34 (ii) an individual practicing within the scope of practice described in Title 58, Chapter
35 60, Part 5, Substance Use Disorder Counselor Act.
36 (c) "Mental health treatment" means treatment for a mental health condition.
37 (2) (a) Except as provided in Subsection (3), beginning January 1, 2023, a health
38 benefit plan that offers coverage for mental health treatment shall, upon request of a health
39 benefit plan enrollee who is employed as a health care provider, offer a single case agreement
40 that allows the enrollee to receive covered mental health treatment from an out-of-network
41 mental health provider selected by the enrollee.
42 (b) A single case agreement described in Subsection (2)(a) shall:
43 (i) reimburse the out-of-network mental health provider for the covered mental health
44 treatment at the equivalent out-of-network rate set by the health benefit plan, subject to the
45 member cost sharing requirements imposed by the health benefit plan;
46 (ii) include the same coinsurance, copayments, and deductibles that would be applied
47 for the mental health treatment if provided by a mental health provider who is a network
48 provider;
49 (iii) include the terms that a network provider is subject to under the health benefit
50 plan; and
51 (iv) define the length and scope of the agreement.
52 (3) Subsection (2) does not apply if:
53 (a) (i) the health benefit plan has network providers for the covered mental health
54 treatment; and
55 (ii) the network providers described in Subsection (3)(a)(i) do not provide the covered
56 mental health treatment in the location where the enrollee works as a health care provider; or
57 (b) the enrollee selects a mental health provider for the covered mental health treatment
58 who the health benefit plan knows or suspects has committed a fraudulent insurance act as
59 described in Section 31A-31-103.