Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 78 First Substitute (2023GS)

Sponsor

Rep. Eliason, S.

Final action

Governor Signed 3/21/2023

Outcome

Became law — signed by Gov. Spencer J. Cox

Summary

What it does

• This bill:
• defines terms; and
• subject to certain conditions and exceptions, requires certain health benefit plans to:
• upon request of an enrollee who is a health care provider, offer a single case agreement for covered behavioral health treatment; and
• include certain terms in the single case agreement.

Every vote on this bill

Bill text

BEHAVIORAL HEALTH TREATMENT ACCESS AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Steve Eliason
Senate Sponsor: 
Jen Plumb
LONG TITLE
General Description:
This bill addresses insurance coverage for behavioral health services.
Highlighted Provisions:
This bill:
▸ defines terms; and
▸ subject to certain conditions and exceptions, requires certain health benefit plans to:
• upon request of an enrollee who is a health care provider, offer a single case
agreement for covered behavioral health treatment; and
• include certain terms in the single case agreement.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
ENACTS:
31A-22-658
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
31A-22-658
 is enacted to read:
 31A-22-658.
Health care provider behavioral health treatment -- Single case
agreement.
(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.