Utah Code § 31A-22-658 — Utah Code / Title 31A / Chapter 31A-22 / § 31A-22-658
§ 31A-22-658. Health care provider behavioral health treatment -- Single case agreement.
Status: in_force

(1) As used in this section: (a) "Mental health condition" means the same as that term is defined in Section 31A-22-649.5. (b) "Mental health provider" means: (i) a mental health therapist, as defined in Section 58-60-102; or (ii) an individual practicing within the scope of practice described in Title 58, Chapter 60, Part 5, Substance Use Disorder Counselor Act. (c) "Mental health treatment" means treatment for a mental health condition. (2) (a) Except as provided in Subsection (3), and subject to Subsections (4) and (5), beginning January 1, 2024, a health benefit plan that offers coverage for mental health treatment shall, upon request of a health benefit plan enrollee who is employed as a health care provider, offer a single case agreement that allows the enrollee to receive covered mental health treatment from an out-of-network mental health provider selected by the enrollee. (b) A single case agreement described in Subsection (2)(a) shall: (i) reimburse the out-of-network mental health provider for the covered mental health treatment at the equivalent out-of-network rate set by the health benefit plan, subject to the member cost-sharing requirements imposed by the health benefit plan; (ii) include the same coinsurance, copayments, and deductibles that would be applied for the mental health treatment if the mental health treatment was provided by a mental health provider who is a network provider; (iii) include the terms that a network provider is subject to under the health benefit plan; and (iv) define the length and scope of the single case agreement. (3) (a) Subsection (2) does not apply if: (i) (A) the health benefit plan has network providers for the covered mental health treatment; and (B) the network providers described in Subsection (3)(a)(i) do not provide the covered mental health treatment in the location where the enrollee works as a health care provider; or (ii) the enrollee selects a mental health provider for the covered mental health treatment who the health benefit plan knows or reasonably suspects has committed a fraudulent insurance act as described in Section 31A-31-103. (b) For purposes of this Subsection (3), the location where an enrollee works as a health care provider includes all locations or facilities of the enrollee's employer. (4) Mental health treatment provided pursuant to a single case agreement under this section: (a) shall be: (i) within the out-of-network mental health provider's scope of practice; and (ii) a service that is otherwise covered under the enrollee's health benefit plan; and (b) may not be experimental. (5) (a) An enrollee shall request a single case agreement under Subsection (2) prior to receiving mental health treatment from an out-of-network mental health provider. (b) With a request for a single case agreement under Subsection (2), an enrollee shall provide information about where the enrollee works as a health care provider sufficient for the health benefit plan to determine whether the circumstances described in Subsection (3)(a)(i) exist.