Representative Steve Eliason proposes the following substitute bill:




Chief Sponsor: Steve Eliason

Senate Sponsor: Jen Plumb


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:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     ENACTS:
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
28     agreement.
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), 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
63     section:
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)
73     exist.