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This page lists some of the action toward parity compliance undertaken by Utah regulatory agencies since 2008.

Are we missing any actions taken by state regulatory agencies? Let us know at info@paritytrack.org.

Action in the Regulatory Arena

7/2018

Primary Focus: Access to Services
Agency: Health, Health Care Financing, Coverage and Reimbursement Policy
Title/Description:  Covered Services
Citation: U.A.C. R414-42-3 
Summary: Covered services may be delivered by means of telemedicine, as clinically appropriate. Services include consultation services, evaluation and management services, mental health services, substance use disorder services, and telepsychiatric consultations.
Effective Date:  December 29, 2008 (Last Substantive Amendment July 1, 2018)
Notes: N/A

4/2017

Primary Focus: Parity
Agency: Utah Department of Insurance
Title/Description:  2018 Plan Year Requirements for Health Benefit Plan and Stand-Alone Dental Plan Filings Subject to PPACA
Citation: Bulletin 2017-1(a)
Summary: Coverage for the medical treatment of mental illness and substance use disorder shall comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and applicable federal regulations.
Effective Date:  April 25, 2017
Notes: N/A

3/2015

The Utah Insurance Department issued a bulletin regarding small employer fully-insured plans and individual plans. It clarified that services for behavioral health disorders must be covered at the same terms and conditions as other services for other medical conditions (page 7). It also clarified that individual plans must cover autism services starting on January 1, 2016 (page 7).

1/2015

The Utah Insurance Department sent a survey to some insurers. One of the survey items about transitional plans reminded insurers that while these plans do not have to comply with much of the Affordable Care Act, they do have to comply with the Federal Parity Law.

4/2014

The Utah Insurance Department issued a bulletin regarding small employer fully-insured plans and individual plans. It clarified that services for behavioral health conditions must be covered at the same terms and conditions as other services for other medical conditions (page 7).

2/2014

The Utah Insurance Department sent a survey to some insurers that offer individual plans and small employer fully-insured plans. One of the survey items about transitional plans reminded insurers that while these plans do not have to comply with much of the Affordable Care Act, they do have to comply with the Federal Parity Law.

Utah Parity Law

There is one section of the state insurance law about behavioral health coverage and another section about autism coverage.

Behavioral Health Coverage

This section of the insurance law is about behavioral health coverage. Large employer fully-insured plans must offer optional behavioral health coverage that complies with the Federal Parity Law. Individual plans must cover behavioral health services and that coverage must comply with the Federal Parity Law.

There is contradictory language in this section about small employer fully-insured plans. A subsection of the law was added in 2014 that requires small employer fully-insured plans to cover behavioral health services and comply with the Federal Parity Law. Older subsections of the law do not require these plans to provide coverage for behavioral health services that complies with the Federal Parity Law. It is the opinion of ParityTrack that these older subsections are no longer relevant and they will not be summarized here. If you know or believe otherwise, please contact us at info@paritytrack.org.

Autism Coverage

Beginning on January 1, 2016 this section of the law requires individual plans and large employer fully-insured plans to cover autism services for children age 2 through age 9.

Plans must cover 600 hours per year of “behavioral health treatment,” which includes applied behavior analysis.

Deductibles, copayments, coinsurance, and annual limits must be the same for autism services as what are in place for other medical coverage.

Insurance plans can only review a child’s treatment plan once every 6 months.

Autism spectrum disorder is defined as “pervasive developmental disorders as defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).”

Autism treatment is defined as:

Plans can be exempted from complying with section of the law if they can demonstrate that premium costs rose by at least 1% because of complying with this section.

Get Support

Utah Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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