Utah Code 31A-45-402. Alcohol and drug dependency treatment

31A-45-402. Alcohol and drug dependency treatment.

(1)

A managed care organization offering a health benefit plan providing coverage for alcohol or drug dependency treatment may require an inpatient facility to be licensed by:

Terms Used In Utah Code 31A-45-402

Agency: means :

(a)	a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and

(b)

an insurance organization licensed or required to be licensed under Section 31A-23a-301, 31A-25-207, or 31A-26-209. See Utah Code 31A-1-301

benefit: means the health care services to which a covered person is entitled under the terms of a health care insurance plan offered by a managed care organization. See Utah Code 31A-45-102

Department: means the Insurance Department. 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

Managed care organization: means :

(a)	a managed care organization as that term is defined in Section 31A-1-301; and

(b)

a third party administrator as that term is defined in Section 31A-1-301. See Utah Code 31A-45-102

State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5

(a)

(i)	the Department of Health and Human Services, under 1; or

(ii)	the Department of Health and Human Services; or

(b)	for an inpatient facility located outside the state, a state agency similar to one described in Subsection (1)(a).

(2)

For inpatient coverage provided pursuant to Subsection (1), a managed care organization may require an inpatient facility to be accredited by the following:

(a)	the Joint Commission; and

(b)	one other nationally recognized accrediting agency.

Amended by Chapter 328, 2023 General Session

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