House advances bill to improve accuracy of behavioral health provider directories
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Summary
House passage of HB71 (second substitute) would require health insurers to more actively verify behavioral health provider directories, offer single-case agreements when a plan lacks an in-network provider for a condition, and create a stakeholder working group to explore a supplemental statewide provider database; second substitute passed 65-5.
The Utah House on Feb. 5 approved a second substitute to HB71, a bill aimed at improving access to behavioral health care by requiring health insurers to maintain more accurate provider directories and to help insureds access care when directories are deficient.
Sponsor described the bill as responding to an audit by the Utah Legislative Auditor General that found roughly two-thirds of entries in commercial behavioral-health directories were inaccurate or "ghost" providers. The bill requires insurers to more frequently verify directory data and to send notice letters to providers who do not respond to verification requests. If an insured cannot find an in-network provider for their condition, the insurer must attempt to arrange a single-case agreement with an out-of-network private provider so the insured can receive covered care.
The substitute also establishes a temporary stakeholder working group that would explore building a supplemental searchable statewide database of behavioral-health providers, including cash-pay clinicians, that could be shared via APIs with insurers and other directories. Sponsor noted the proposal is intended to improve consumer access without creating disciplinary sanctions for clinicians as an initial enforcement step.
Representative Dunigan questioned what consequences would follow if providers do not respond to verification letters; the sponsor said the bill is a first step and that stronger sanctions, including licensure consequences, remain a future policy discussion if data show nonresponse is widespread.
Representative Hollins, who identified as an LCSW, thanked the sponsor for working with social-work stakeholders. The House passed the second substitute 65-5 and the bill will be sent to the Senate.
