31A-22-663. Timely access to behavioral health services -- Single case agreement.

640 words·~3 min read·/ut/title-31a/chapter-22/31a-22-663·

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

Effective 5/6/2026

(1)As used in this section:

(a)"Covered insurer" means an insurer that offers health insurance that includes coverage for behavioral health services.

(i)"Behavioral health services" means:

(A)mental health treatment or services; or

(B)substance use treatment or services.

(ii)"Behavioral health services" includes telehealth services and telemedicine services.

(c)"Insurer" means the same as that term is defined in Section 31A-22-634 .

(d)"Mental health provider" means the same as that term is defined in Section 31A-22-658 .

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

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

(g)"Timely manner" means:

(i)no more than 15 days after the day on which an insured first attempts to access behavioral health services; and

(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.

(2)Beginning January 1, 2027, a covered insurer shall:

(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

(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.

(a)A covered insurer shall include in a negotiated single case agreement described in Subsection (2)(b) :

(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;

(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;

(iii)any terms that a network provider is subject to under the health benefit plan; and

(iv)the length and scope of the single case agreement.

(b)Notwithstanding Subsection (3)(a)(ii) :

(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

(ii)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 Subsection (2)(b) only permits an insured to receive behavioral health services:

(a)that are:

(i)within the out-of-network mental health provider's scope of practice; and

(ii)behavioral health services that are otherwise covered under the enrollee's health benefit plan; and

(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.

(5)A covered insurer shall:

(a)document all payments the covered insurer makes under a health benefit plan to a mental health provider under this section; and

(b)provide the documentation described in Subsection (5)(a) to the department upon request.

(6)Subsections (2)(b) , (3), and

(4)do not apply if behavioral health services are available in a timely manner.

(7)The commissioner may:

(a)make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section; and

(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.

Enacted by Chapter 50 , 2026 General Session