§ 31A-22-652 — Coverage for mental health services in schools.

Utah § 31A-22-652

• Jurisdiction: Utah
• Title 31A: Insurance Code
• Ch. 31A-22: Contracts in Specific Lines
• Part 31A-22-6: Accident and Health Insurance

Text

(1) As used in this section, "local education agency" means:

(1)(a) a school district;
(1)(b) a charter school; or
(1)(c) the Utah Schools for the Deaf and the Blind.
(2) A health benefit plan that is entered into or renewed on or after January 1, 2020, may not deny a claim for a covered mental health service solely because the mental health service is provided:

(2)(a) at a local education agency building or facility; or
(2)(b) by an employee or contractor of a local education agency.
(3) Nothing in this section:

(3)(a) prohibits a health benefit plan from denying a claim:
(3)(a)(i) by an individual that is not a licensed health care provider;
(3)(a)(ii) by a health care provider practicing outside the health care provider's scope of practice;
(3)(a)(iii) that is submitted by a person that is not a network provider;
(3)(a)(iv) for a mental health service that is not medically necessary as determined by the health benefit plan; or
(3)(a)(v) that does not otherwise comply with the health benefit plan's policies; or
(3)(b) requires a health benefit plan to pay a claim for a service that is:
(3)(b)(i) provided under an individualized education program as defined in Section 53E-4-301; or
(3)(b)(ii) administrative in nature to the local education agency.

Legislative History

Enacted by Chapter 172, 2019 General Session