31A-22-663. Timely access to behavioral health services -- Single case agreement.
(1) As used in this section: "Covered insurer" means an insurer that offers health insurance that includes coverage for behavioral health services. "Behavioral health services" means: mental health treatment or services; or substance use treatment or services. "Behavioral health services" includes telehealth services and telemedicine services. "Insurer" means the same as that term is defined in Section. 31A-22-634 "Mental health provider" means the same as that term is defined in Section. 31A-22-658 "Telehealth services" means the same as that term is defined in Section. 26B-4-704 "Telemedicine services" means the same as that term is defined in Section. 26B-4-704 "Timely manner" means: no more than 15 days after the day on which an insured first attempts to access behavioral health services; and no more than 24 hours after the date and time that an insured first seeks to access urgent, emergency, or crisis behavioral health services.
(2) Beginning January 1, 2027, a covered insurer shall: establish a procedure to assist an enrollee to access behavioral health services from an out-of-network mental health provider when no in-network mental health provider is available in a timely manner; and if an enrollee in a covered insurer's health benefit plan is unable to obtain covered behavioral health services from an in-network mental health provider in a timely manner, enter into a single case agreement that allows the enrollee to receive covered behavioral health services from an out-of-network mental health provider.
(3) A covered insurer shall include in a negotiated single case agreement described in Subsection: (2)(b) a requirement that the covered insurer reimburse the out-of-network mental health provider for the covered behavioral health services at a rate negotiated by the provider and insurer, subject to the member cost-sharing requirements imposed by the health benefit plan; a requirement that the covered insurer apply the same coinsurance, copayments, and deductibles that would apply for the behavioral health services if the behavioral health services were provided by a mental health provider that is an in-network mental health provider; any terms that a network provider is subject to under the health benefit plan; and the length and scope of the single case agreement. Notwithstanding Subsection: (3)(a)(ii) a covered insurer's payment under a single case agreement described in Subsectionconstitutes payment in full to the provider for the behavioral health services the enrollee receives; and (2)(b) the provider may not seek additional payment from the enrollee except for applicable cost sharing.
(4) A covered insurer shall ensure that a single case agreement described in Subsectiononly permits an insured to receive behavioral health services: (2)(b) that are: within the out-of-network mental health provider's scope of practice; and behavioral health services that are otherwise covered under the enrollee's health benefit plan; and that are not experimental, unless the insurer covers experimental treatments for physical health conditions in compliance with the Mental Health Parity and Addiction Equity Act, Pub. L. No. 110-343.
(5) A covered insurer shall: document all payments the covered insurer makes under a health benefit plan to a mental health provider under this section; and provide the documentation described in Subsectionto the department upon request. (5)(a)
(6) Subsections, (3), and (4) do not apply if behavioral health services are available in a timely manner. (2)(b)
(7) The commissioner may: make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section; and bring an action in accordance with Sectionand Title 63G, Chapter 4, Administrative Procedures Act, for a violation of this section. 31A-2-308