Utah Code 31A-22-652. Coverage for mental health services in schools
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(1) As used in this section, “local education agency” means:
Terms Used In Utah Code 31A-22-652
- Agency: means :(6)(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and(6)(b) an insurance organization licensed or required to be licensed under Section
31A-23a-301 ,31A-25-207 , or31A-26-209 . See Utah Code 31A-1-301- Employee: means :
(57)(a) an individual employed by an employer; or(57)(b) an individual who meets the requirements of Subsection (55)(b). See Utah Code 31A-1-301- Health benefit plan: means a policy, contract, certificate, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care, including major medical expense coverage. See Utah Code 31A-1-301
- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301- Health care provider: means the same as that term is defined in Section
78B-3-403 . See Utah Code 31A-1-301- Individual: means a natural person. See Utah Code 31A-1-301
- Network provider: means a health care provider who has an agreement with a managed care organization to provide health care services to an enrollee with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly from the managed care organization. See Utah Code 31A-1-301
- Person: includes :
(146)(a) an individual;(146)(b) a partnership;(146)(c) a corporation;(146)(d) an incorporated or unincorporated association;(146)(e) a joint stock company;(146)(f) a trust;(146)(g) a limited liability company;(146)(h) a reciprocal;(146)(i) a syndicate; or(146)(j) another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301(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. - Employee: means :