care. (1) As used in this section: (a) (i) "Covered child" means an insured child who: (A) while in the custody of the Division of Child and Family Services, was receiving mental health treatment or services from a covered mental health therapist; and (B) is no longer in the custody of the Division of Child and Family Services. (ii) "Covered child" includes a covered child's parent or guardian acting on behalf of the covered child. (iii) "Covered child" does not include an insured child who, while in the custody of the Division of Child and Family Services, was receiving mental health treatment or services from: (A) a residential treatment program, as that term is defined in Section 26B-2-101; (B) a day treatment program or partial hospitalization program; or (C) any other facility that provides a level of care higher than traditional outpatient services where mental health treatment or services are integrated into the facility's specialized program of care. (b) "Covered insurer" means an insurer that offers a health benefit plan that includes coverage for mental health treatment or services. (c) "Covered mental health therapist" means a mental health therapist who provides mental health treatment and services to a covered child while the covered child is in the custody of the Division of Child and Family Services. (d) "Insurer" means the same as that term is defined in Section 31A-22-634. (e) "Insured child" means a child who is an enrollee in a covered insurer's health benefit plan that offers health insurance that includes coverage for mental health treatment or services. (f) "Mental health therapist" means a mental health therapist as that term is defined in Section 58-60-102. (2) A covered insurer shall, upon request of a covered child, offer a single case agreement that allows a covered child to receive covered mental health treatment and services from an out-of- network covered mental health therapist, if: (a) the covered child was in the custody of the Division of Child and Family Services no more than 90 days before the day on which the covered child requests the single case agreement; and (b) the covered mental health therapist agrees to enter the single case agreement. (3) A covered insurer shall include in a single case agreement described in Subsection (2): (a) a requirement that the covered insurer reimburse the out-of-network provider for the covered mental health treatment and services at an in-network rate by the covered insurer, subject to the member cost-sharing requirements imposed by the health benefit plan; (b) a requirement that the covered insurer apply the same coinsurance, copayments, and deductibles that would apply for the mental health treatment and services if the mental health treatment and services were provided by a mental health therapist that is a network provider; (c) any terms that a network provider is subject to under the health benefit plan; and (d) the length and scope of the single case agreement. (4) Nothing in this section may be construed to require a covered insurer to pay an out-of-network covered mental health therapist for services that are not otherwise covered under the covered child's health benefit plan. (5) A covered child shall: (a) request a single case agreement under Subsection (2) before the covered child receives mental health treatment or services from the covered mental health therapist; and (b) provide documentation with the request for a single case agreement under Subsection (2): (i) that the covered child received mental health treatment from the covered mental health therapist while in the custody of the Division of Child and Family Services; and (ii) of when the covered child left the custody of the Division of Child and Family Services. (6) The commissioner may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section.
‹ Prev All Utah sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.