{"data":{"id":"us-ut/utah-code-31a-22-663","jurisdiction":"us-ut","citation":"Utah Code § 31A-22-663","heading":"Timely access to behavioral health services -- Single case agreement.","body":"(1) As used in this section:\n(a) \"Covered insurer\" means an insurer that offers health insurance that includes coverage for behavioral health services.\n(b)\n(i) \"Behavioral health services\" means:\n(A) mental health treatment or services; or\n(B) substance use treatment or services.\n(ii) \"Behavioral health services\" includes telehealth services and telemedicine services.\n(c) \"Insurer\" means the same as that term is defined in Section 31A-22-634.\n(d) \"Mental health provider\" means the same as that term is defined in Section 31A-22-658.\n(e) \"Telehealth services\" means the same as that term is defined in Section 26B-4-704.\n(f) \"Telemedicine services\" means the same as that term is defined in Section 26B-4-704.\n(g) \"Timely manner\" means:\n(i) no more than 15 days after the day on which an insured first attempts to access behavioral health services; and\n(ii) no more than 24 hours after the date and time that an insured first seeks to access urgent, emergency, or crisis behavioral health services.\n(2) Beginning January 1, 2027, a covered insurer shall:\n(a) 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\n(b) 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.\n(3)\n(a) A covered insurer shall include in a negotiated single case agreement described in Subsection (2)(b):\n(i) 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;\n(ii) 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;\n(iii) any terms that a network provider is subject to under the health benefit plan; and\n(iv) the length and scope of the single case agreement.\n(b) Notwithstanding Subsection (3)(a)(ii):\n(i) a covered insurer's payment under a single case agreement described in Subsection (2)(b) constitutes payment in full to the provider for the behavioral health services the enrollee receives; and\n(ii) the provider may not seek additional payment from the enrollee except for applicable cost sharing.\n(4) A covered insurer shall ensure that a single case agreement described in Subsection (2)(b) only permits an insured to receive behavioral health services:\n(a) that are:\n(i) within the out-of-network mental health provider's scope of practice; and\n(ii) behavioral health services that are otherwise covered under the enrollee's health benefit plan; and\n(b) 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.\n(5) A covered insurer shall:\n(a) document all payments the covered insurer makes under a health benefit plan to a mental health provider under this section; and\n(b) provide the documentation described in Subsection (5)(a) to the department upon request.\n(6) Subsections (2)(b), (3), and (4) do not apply if behavioral health services are available in a timely manner.\n(7) The commissioner may:\n(a) make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section; and\n(b) bring an action in accordance with Section 31A-2-308 and Title 63G, Chapter 4, Administrative Procedures Act, for a violation of this section.","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-S663.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"f1ac6312d0389185edfdc4e53e4160a0c6ffed76c14b3838d11f1ea97a5c33c1","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-22-662","next":"us-ut/utah-code-31a-22-664"},"notice":"GroundRules: Original legal text. Not legal advice."}