7 LONG TITLE
8 General Description:
9 This bill addresses insurance coverage for behavioral health services.
10 Highlighted Provisions:
11 This bill:
12 ▸ defines terms; and
13 ▸ subject to certain conditions and 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:
19 Other Special Clauses:
21 Utah Code Sections Affected:
23 31A-22-658, Utah Code Annotated 1953
25 Be it enacted by the Legislature of the state of Utah:
26 Section 1. Section 31A-22-658 is enacted to read:
27 31A-22-658. Health care provider behavioral health treatment -- Single case
29 (1) As used in this section:
30 (a) "Mental health condition" means the same as that term is defined in Section
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), and subject to Subsections (4) and (5),
38 beginning January 1, 2024, a health benefit plan that offers coverage for mental health
39 treatment shall, upon request of a health benefit plan enrollee who is employed as a health care
40 provider, offer a single case agreement that allows the enrollee to receive covered mental
41 health treatment from an out-of-network 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 the mental health treatment was provided by a mental health
48 provider who is a network 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 single case agreement.
52 (3) (a) Subsection (2) does not apply if:
53 (i) (A) the health benefit plan has network providers for the covered mental health
54 treatment; and
55 (B) 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 (ii) the enrollee selects a mental health provider for the covered mental health
58 treatment who the health benefit plan knows or reasonably suspects has committed a fraudulent
59 insurance act as described in Section 31A-31-103.
60 (b) For purposes of this Subsection (3), the location where an enrollee works as a
61 health care provider includes all locations or facilities of the enrollee's employer.
62 (4) Mental health treatment provided pursuant to a single case agreement under this
64 (a) shall be:
65 (i) within the out-of-network mental health provider's scope of practice; and
66 (ii) a service that is otherwise covered under the enrollee's health benefit plan; and
67 (b) may not be experimental.
68 (5) (a) An enrollee shall request a single case agreement under Subsection (2) prior to
69 receiving mental health treatment from an out-of-network mental health provider.
70 (b) With a request for a single case agreement under Subsection (2), an enrollee shall
71 provide information about where the enrollee works as a health care provider sufficient for the
72 health benefit plan to determine whether the circumstances described in Subsection (3)(a)(i)