31A-22-658. Health care provider behavioral health treatment -- Single case agreement.
(1) As used in this section: "Mental health condition" means the same as that term is defined in Section. 31A-22-649.5 "Mental health provider" means: a mental health therapist, as defined in Section; or 58-60-102 an individual practicing within the scope of practice described in. Title 58, Chapter 60, Part 5, Substance Use Disorder Counselor Act "Mental health treatment" means treatment for a mental health condition.
(2) Except as provided in Subsection, and subject to Subsectionsand, 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. (3) (4) (5) A single case agreement described in Subsectionshall: (2)(a) 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; 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; include the terms that a network provider is subject to under the health benefit plan; and define the length and scope of the single case agreement.
(3) Subsectiondoes not apply if: (2) the health benefit plan has network providers for the covered mental health treatment; and the network providers described in Subsectiondo not provide the covered mental health treatment in the location where the enrollee works as a health care provider; or (3)(a)(i) 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 For purposes of this Subsection, the location where an enrollee works as a health care provider includes all locations or facilities of the enrollee's employer. (3)
(4) Mental health treatment provided pursuant to a single case agreement under this section: shall be: within the out-of-network mental health provider's scope of practice; and a service that is otherwise covered under the enrollee's health benefit plan; and may not be experimental.
(5) An enrollee shall request a single case agreement under Subsectionprior to receiving mental health treatment from an out-of-network mental health provider. (2) With a request for a single case agreement under Subsection, 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 Subsectionexist. (2) (3)(a)(i)