31A-22-649. Coverage of telepsychiatric consultations.

500 words·~2 min read·/ut/title-31a/chapter-22/31a-22-649

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/3/2023

(1)As used in this section:

(a)"Telehealth services" means the same as that term is defined in Section 26B-4-704 .

(b)"Telepsychiatric consultation" means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

(i)the health records of the patient, provided from the patient or the referring physician;

(ii)a written, evidence-based patient questionnaire; and

(iii)telehealth services that meet industry security and privacy standards, including compliance with the:

(A)Health Insurance Portability and Accountability Act; and

(B)Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.

(2)Beginning January 1, 2019, a health benefit plan that offers coverage for mental health services shall:

(a)provide coverage for a telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;

(b)provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if a telepsychiatric consultation is not made available to a physician within seven business days after the initial request is made by the physician to an in-network provider of telepsychiatric consultations; and

(c)reimburse for the services described in Subsections (2)(a) and

(b)at the equivalent in-network or out-of-network rate set by the health benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

(3)A single telepsychiatric consultation includes all contacts, services, discussion, and information review required to complete an individual request from a referring physician for a patient.

(4)An insurer may satisfy the requirement to cover a telepsychiatric consultation described in Subsection (2)(a) for a patient by:

(a)providing coverage for behavioral health treatment, as defined in Section 31A-22-642 , in person or using telehealth services; and

(b)ensuring that the patient receives an appointment for the behavioral health treatment in person or using telehealth services on a date that is within seven business days after the initial request is made by the in-network referring physician.

(5)A referring physician who uses a telepsychiatric consultation for a patient shall, at the time that the questionnaire described in Subsection (1)(b)(ii) is completed, notify the patient that:

(a)the referring physician plans to request a telepsychiatric consultation; and

(b)additional charges to the patient may apply.

(a)An insurer may receive a temporary waiver from the department from the requirements in this section if the insurer demonstrates to the department that the insurer is unable to provide the benefits described in this section due to logistical reasons.

(b)An insurer that receives a waiver from the department under Subsection (6)(a) is subject to the requirements of this section beginning July 1, 2019.

(7)This section does not limit an insurer from engaging in activities that ensure payment integrity or facilitate review and investigation of improper practices by health care providers.

Amended by Chapter 328 , 2023 General Session