(1) As used in this section, "local education agency" means: (a) a school district; (b) a charter school; or (c) the Utah Schools for the Deaf and the Blind.
(a) a school district;
(b) a charter school; or
(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: (a) at a local education agency building or facility; or (b) by an employee or contractor of a local education agency.
(a) at a local education agency building or facility; or
(b) by an employee or contractor of a local education agency.
(3) Nothing in this section: (a) prohibits a health benefit plan from denying a claim: (i) by an individual that is not a licensed health care provider; (ii) by a health care provider practicing outside the health care provider's scope of practice; (iii) that is submitted by a person that is not a network provider; (iv) for a mental health service that is not medically necessary as determined by the health benefit plan; or (v) that does not otherwise comply with the health benefit plan's policies; or (b) requires a health benefit plan to pay a claim for a service that is: (i) provided under an individualized education program as defined in Section 53E-4-301; or (ii) administrative in nature to the local education agency.
(a) prohibits a health benefit plan from denying a claim: (i) by an individual that is not a licensed health care provider; (ii) by a health care provider practicing outside the health care provider's scope of practice; (iii) that is submitted by a person that is not a network provider; (iv) for a mental health service that is not medically necessary as determined by the health benefit plan; or (v) that does not otherwise comply with the health benefit plan's policies; or
(i) by an individual that is not a licensed health care provider;
(ii) by a health care provider practicing outside the health care provider's scope of practice;
(iii) that is submitted by a person that is not a network provider;
(iv) for a mental health service that is not medically necessary as determined by the health benefit plan; or
(v) that does not otherwise comply with the health benefit plan's policies; or
(b) requires a health benefit plan to pay a claim for a service that is: (i) provided under an individualized education program as defined in Section 53E-4-301; or (ii) administrative in nature to the local education agency.
(i) provided under an individualized education program as defined in Section 53E-4-301; or
(ii) administrative in nature to the local education agency.
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