{"data":{"id":"us-ut/utah-code-31a-22-658","jurisdiction":"us-ut","citation":"Utah Code § 31A-22-658","heading":"Health care provider behavioral health treatment -- Single case agreement.","body":"(1) As used in this section:\n(a) \"Mental health condition\" means the same as that term is defined in Section 31A-22-649.5.\n(b) \"Mental health provider\" means:\n(i) a mental health therapist, as defined in Section 58-60-102; or\n(ii) an individual practicing within the scope of practice described in Title 58, Chapter 60, Part 5, Substance Use Disorder Counselor Act.\n(c) \"Mental health treatment\" means treatment for a mental health condition.\n(2)\n(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.\n(b) A single case agreement described in Subsection (2)(a) shall:\n(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;\n(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;\n(iii) include the terms that a network provider is subject to under the health benefit plan; and\n(iv) define the length and scope of the single case agreement.\n(3)\n(a) Subsection (2) does not apply if:\n(i)\n(A) the health benefit plan has network providers for the covered mental health treatment; and\n(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\n(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.\n(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.\n(4) Mental health treatment provided pursuant to a single case agreement under this section:\n(a) shall be:\n(i) within the out-of-network mental health provider's scope of practice; and\n(ii) a service that is otherwise covered under the enrollee's health benefit plan; and\n(b) may not be experimental.\n(5)\n(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.\n(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.","path":["Title 31A Insurance Code","Chapter 31A-22 Contracts in Specific Lines","Part 31A-22-6 Accident and Health Insurance"],"source_url":"https://le.utah.gov/xcode/Title31A/Chapter22/31A-22-S658.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"bd68232e9cfb8a14d89ec4a0eeb5f8f1e80d80ab2814f2d2bd957788bf466cf8","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-22-657","next":"us-ut/utah-code-31a-22-659"},"notice":"GroundRules: Original legal text. Not legal advice."}