HB 71 — Health Provider Directory and Access Amendments

31A-22-664.31A-22-664 .

(a){(b)}(b) "Exempt health care professional" means a person exempt from licensure under a title listed in Subsection 58-13-3(2)(c).

(b){(c)}(c) "Exempt mental health provider" means an individual exempt from licensure under Section 58-60-107.

(c){(d)}(d) "Health care facility" means the same as that term is defined in Section 26B-2-201.

(d){(e)}(e) "Health care professional" means the same as that term is defined in Section 58-13-3.

(e){(f)}(f) "Hospital" means a facility licensed under Title 26B, Chapter 2, Part 2, Health Care Facility Licensing and Inspection, as a general acute hospital or specialty hospital.

(f){(g)}(g) "Insurer" means the same as that term is defined in Section 31A-22-634.

(g){(h)}(h) "Mental health provider" means the same as that term is defined in Section 31A-22-658.

(h){(i)}(i) "Pharmacy" means the same as that term is defined in Section 58-17b-102.

(i){(j)}(j) "Provider" means:

(j){(k)}(k) "Provider directory" means a list of in-network providers for each of an insurer's health- benefit4 plans.- Enrolled Copy H.B.

(k){(l)}71 "Telehealthhealth services"benefit meansplans. the same as that term is defined in Section 26B-4-704.

(l){(m)}(l) "Telemedicine"Telehealth services" means the same as that term is defined in Section 26B-4-704.

(2)(m) Beginning"Telemedicine {Julyservices" }means Januarythe 1,same {2026}as 2027,that anterm insureris shall:defined in Section 26B-4-704.

(2) Beginning January 1, 2027, an insurer shall:

and - 5 - HB0071 compared with HB0071S04 (b) update the provider directory no less frequently than every 60 days.

(3) An insurer shall ensure that, except as provided in Subsection {(6)} (7):

(ii) on the {covered } insurer's website;

(a)- a5 provider- directoryH.B. of health care professionals and exempt health care professionals shall include:

71 Enrolled Copy (a) a provider directory of health care professionals and exempt health care professionals shall include:

and - 6 - HB0071 compared with HB0071S04 (III) phone number;

(ii) whether the health care professional or exempt health care professional is accepting new patients;and {(iii) {if an exempt health care professional treats patients under the supervision of a health care professional, whether the exempt health care professional is accepting new patients;

and}and }(iii) (iv){(iii)} whether the health care professional or exempt health care professional offers telehealth services or telemedicine services;

(ii) if the hospital is a specialty hospital, the specialty type;

(v) {customer service } phone number;

(v) {customer service } phone number;

(iv)- location6 or- locations;Enrolled Copy H.B.

(v)71 {customer(iv) servicelocation }or phonelocations; number;

(v) phone number;

and - 7 - HB0071 compared with HB0071S04 (e) a provider directory of mental health providers and exempt mental health providers shall include:

(ii) whether the mental health provider or exempt mental health provider is accepting new patients;and {(iii) {if an exempt mental health provider treats patients under the supervision of a mental health provider, whether the exempt mental health provider is accepting new patients;

and}and }(iii) (iv){(iii)} whether the mental health provider or exempt mental health provider offers telehealth services or telemedicine services.

(6)(6)(a) (a) For purposes of Subsection (5)(a)(ii), a health care professional is accepting new patients if an exempt health care professional who treats patients under the supervision of the health care professional is available to see new patients.

(7)(7)(a) (a) An insurer may provide, in addition to an electronic provider directory, a provider directory in print format.

- 8 - HB0071 compared with HB0071S04 (iii) a disclosure that the information in the provider directory is accurateaccurate, , to the best of the insurer's knowledge, based on the information the provider provided, as of the date of printing;

and (iv)- a7 notice- thatH.B. an insured or prospective insured should consult the health benefit plan's electronic provider directory or call the health benefit plan's customer service phone number to obtain current provider directory information.

(7){(8)}71 WhenEnrolled Copy (iv) a notice that an insurerinsured receivesor aprospective reportinsured ofshould inaccurateconsult informationthe inhealth abenefit plan's electronic provider directory,directory or call the insurerhealth shall:benefit plan's customer service phone number to obtain current provider directory information.

(8) When an insurer receives a report of inaccurate information in a provider directory, the insurer shall:

and (b) no later than the end of the {second } 20th business day after the day on which the insurer receives the report:

(8){(9)}(9)(a) (a) An insurer shall take steps to ensure the accuracy of the information in a provider directory, including contacting providers to verify that provider information is up to date.

(b) When an insurer contacts a provider to verify the accuracy of a provider's information in a provider directory, the provider shall respond to the insurer's request for verification no later than {10 } 15 business days after the day on which the insurer contacts the provider.

(9){(10)}(10)(a) (a) An insurer shall, at least annually, audit each provider directory for accuracy.

{(b)(b)(i)(A) {An audit of a provider directory shall:} } (i){(b)} (i) (A) include the two mental health specialties and four physical health specialties most utilized by insureds;

or (ii) audit a reasonable sample size of providers, if the sample size includes {behavioral } mental health providers.

(i) retain documentation of each audit performed under this Subsection {(9)} (10);

- 9 - HB0071 compared with HB0071S04 (ii) submit the audit to the commissioner {annually, on or before December 31, and } upon the commissioner's request;

(11)(11)(a) (10){(a)} An insurer shall {annually } report to the commissioner upon request on:

(a){(i)}(i) the number of reports of inaccuracies in provider directories the insurer received;

(b){(ii)}(ii) the timeliness of the insurer's response to a report of inaccuracies in a provider directory;- 8 - Enrolled Copy H.B.

(c){(iii)}71 any corrective action the insurer took in response to a report of inaccuracies in a provider directory;

(iii) any corrective action the insurer took in response to a report of inaccuracies in a provider directory;

(d){(v)}(v) all audits the insurer conducted in accordance with this section;

and (e){(vi)}(vi) any other information related to provider directory accuracy the commissioner considers relevant.

(c)(c)(i) (i) If an insurer finds that a provider demonstrates a repeated pattern of violations of Subsection (9), the insurer shall:

(11){(12)}(12) An insurer, a health care facility, a hospital, or a provider that is subject to this section shall comply with all applicable requirements of the No Surprises Act, 42 U.S.C.

(12){(13)}(13) The commissioner {shall } may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement the provisions of this section.

-(14) 10 - HB0071 compared with HB0071S04 (13){(14)} In addition to the penalties authorized under Section 31A-2-308, if the commissioner determines thatthat, {an } , when an insured received services under the insured's health benefit plan, the insured reasonably relied on inaccurate information in a provider directorydirectory, {when the insured received services covered under the insured's health benefit plan} , the commissioner may:

and (b)- if9 the- commissionerH.B. determines that the provider provided inaccurate information or failed to update the information, require the insurer to reimburse the provider at the in-network rate.

{(14)71 {TheEnrolled DivisionCopy of(b) Professionalif Licensingthe maycommissioner imposedetermines administrativethat penaltiesthe inprovider accordanceprovided withinaccurate Sectioninformation 58-1-502or andfailed theto provider'supdate respectivethe licensinginformation, chapter,require forthe ainsurer provider'sto violationreimburse ofthe Subsectionprovider (8).}at }the Sectionin-network 3.rate.

Section 33. is enacted to read:

58-1-113.Section 58-1-113 is enacted to read:

58-1-113 .

- 11 - HB0071 compared with HB0071S04 (h) "Insurer" means:

(k) "Provider directory" means a provider directory created in accordance with Section 31A-22-664.- 10 - Enrolled Copy H.B.

71 31A-22-664.

- 12 - HB0071 compared with HB0071S04 (A) is accepting new patients;

(viii) allows the division to communicate with a behavioral health provider in the database to prompt the behavioral health provider to review and verify information- in11 the- database;H.B.

71 Enrolled Copy information in the database;

{SectionSection 4.

Section 58-1-501 is amended to read:

} 58-1-501.

Unlawful and unprofessional conduct.

(1) "Unlawful conduct" means conduct, by any person, that is defined as unlawful under this title and includes:

(a) practicing or engaging in, representing oneself to be practicing or engaging in, or attempting to practice or engage in any profession requiring licensure under this title, except the behavioral health technician under Chapter 60, Part 6, Behavioral Health Coach and Technician Licensing Act, if the person is:

(i) not licensed to do so or not exempted from licensure under this title;

or (ii) restricted from doing so by a suspended, revoked, restricted, temporary, probationary, or inactive license;

- 13 - HB0071 compared with HB0071S04 (b) (i) impersonating another licensee or practicing a profession under a false or assumed name, except as permitted by law;

or (ii) for a licensee who has had a license under this title reinstated following disciplinary action, practicing the same profession using a different name than the name used before the disciplinary action, except as permitted by law and after notice to, and approval by, the division;

(c) knowingly employing any other person to practice or engage in or attempt to practice or engage in any profession licensed under this title if the employee is not licensed to do so under this title;

(d) knowingly permitting the person's authority to practice or engage in any profession licensed under this title to be used by another, except as permitted by law;

(e) obtaining a passing score on a licensure examination, applying for or obtaining a license, or otherwise dealing with the division or a licensing board through the use of fraud, forgery, or intentional deception, misrepresentation, misstatement, or omission;

(f) (i) issuing, or aiding and abetting in the issuance of, an order or prescription for a drug or device to a person located in this state:

(A) without prescriptive authority conferred by a license issued under this title, or by an exemption to licensure under this title;

or (B) with prescriptive authority conferred by an exception issued under this title or a multistate practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment;

and (ii) Subsection (1)(f)(i) does not apply to treatment rendered in an emergency, on-call or cross coverage situation, provided that the person who issues the prescription has prescriptive authority conferred by a license under this title, or is exempt from licensure under this title;

or (g) aiding or abetting any other person to violate any statute, rule, or order regulating a profession under this title.

(2) (a) "Unprofessional conduct" means conduct, by a licensee or applicant, that is defined as unprofessional conduct under this title or under any rule adopted under this title and includes:

- 14 - HB0071 compared with HB0071S04 (i) violating any statute, rule, or order regulating an a profession under this title;

(ii) violating, or aiding or abetting any other person to violate, any generally accepted professional or ethical standard applicable to an occupation or profession regulated under this title;

(iii) subject to the provisions of Subsection (4), engaging in conduct that results in conviction, a plea of nolo contendere, or a plea of guilty or nolo contendere that is held in abeyance pending the successful completion of probation with respect to a crime that, when considered with the functions and duties of the profession for which the license was issued or is to be issued, bears a substantial relationship to the licensee's or applicant's ability to safely or competently practice the profession;

(iv) engaging in conduct that results in disciplinary action, including reprimand, censure, diversion, probation, suspension, or revocation, by any other licensing or regulatory authority having jurisdiction over the licensee or applicant in the same profession if the conduct would, in this state, constitute grounds for denial of licensure or disciplinary proceedings under Section 58-1-401;

(v) engaging in conduct, including the use of intoxicants, drugs, narcotics, or similar chemicals, to the extent that the conduct does, or might reasonably be considered to, impair the ability of the licensee or applicant to safely engage in the profession;

(vi) practicing or attempting to practice a profession regulated under this title despite being physically or mentally unfit to do so;

(vii) practicing or attempting to practice a or profession regulated under this title through gross incompetence, gross negligence, or a pattern of incompetency or negligence;

(viii) practicing or attempting to practice a profession requiring licensure under this title by any form of action or communication which is false, misleading, deceptive, or fraudulent;

(ix) practicing or attempting to practice a profession regulated under this title beyond the scope of the licensee's competency, abilities, or education;

(x) practicing or attempting to practice a profession regulated under this title beyond the scope of the licensee's license;

(xi) verbally, physically, mentally, or sexually abusing or exploiting any person through conduct connected with the licensee's practice under this title or otherwise facilitated by the licensee's license;

- 15 - HB0071 compared with HB0071S04 (xii) acting as a supervisor without meeting the qualification requirements for that position that are defined by statute or rule;

(xiii) issuing, or aiding and abetting in the issuance of, an order or prescription for a drug or device:

(A) without first obtaining information in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify conditions, and to identify contraindications to the proposed treatment;

or (B) with prescriptive authority conferred by an exception issued under this title, or a multi-state practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment;

(xiv) violating a provision of Section 58-1-501.5;

(xv) violating the terms of an order governing a license;

[or] (xvi) violating Section 58-1-511[.] ;

or (xvii) violating Subsection 31A-22-664(8).

(b) "Unprofessional conduct" does not include:

(i) a health care provider, as defined in Section 78B-3-403 and who is licensed under this title, deviating from medical norms or established practices if the conditions described in Subsection (5) are met;

and (ii) notwithstanding Section 58-1-501.6, a health care provider advertising that the health care provider deviates from medical norms or established practices, including the maladies the health care provider treats, if the health care provider:

(A) does not guarantee any results regarding any health care service;

(B) fully discloses on the health care provider's website that the health care provider deviates from medical norms or established practices with a conspicuous statement;

and (C) includes the health care provider's contact information on the website.

(3) Unless otherwise specified by statute or administrative rule, in a civil or administrative proceeding commenced by the division under this title, a person subject to any of the unlawful and unprofessional conduct provisions of this title is strictly liable for each violation.

(4) The following are not evidence of engaging in unprofessional conduct under Subsection (2)(a)(iii):

(a) an arrest not followed by a conviction;

or - 16 - HB0071 compared with HB0071S04 (b) a conviction for which an individual's incarceration has ended more than five years before the date of the division's consideration, unless:

(i) after the incarceration the individual has engaged in additional conduct that results in another conviction, a plea of nolo contendere, or a plea of guilty or nolo contendere that is held in abeyance pending the successful completion of probation;

or (ii) the conviction was for:

(A) a violent felony as defined in Section 76-3-203.5;

(B) a felony related to a criminal sexual act under Title 76, Chapter 5, Part 4, Sexual Offenses, or Title 76, Chapter 5b, Sexual Exploitation Act;

(C) a felony related to criminal fraud or embezzlement, including a felony under Title 76, Chapter 6, Part 5, Fraud, or Title 76, Chapter 6, Part 4, Theft;

or (D) a crime or a pattern of crimes that demonstrates a substantial potential to harm Utah patients or consumers, as may be determined by the director in a process defined by rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.

(5) In accordance with Subsection (2)(b)(i), a health care provider may deviate from medical norms or established practices if:

(a) the health care provider does not deviate outside of the health care provider's scope of practice and possesses the education, training, and experience to competently and safely administer the alternative health care service;

(b) the health care provider does not provide an alternative health care service that is otherwise contrary to any state or federal law;

(c) the alternative health care service has reasonable potential to be of benefit to the patient to whom the alternative health care service is to be given;

(d) the potential benefit of the alternative health care service outweighs the known harms or side effects of the alternative health care service;

(e) the alternative health care service is reasonably justified under the totality of the circumstances;

(f) after diagnosis but before providing the alternative health care service:

(i) the health care provider educates the patient on the health care services that are within the medical norms and established practices;

(ii) the health care provider discloses to the patient that the health care provider is recommending an alternative health care service that deviates from medical norms and established practices;

- 17 - HB0071 compared with HB0071S04 (iii) the health care provider discusses the rationale for deviating from medical norms and established practices with the patient;

(iv) the health care provider discloses any potential risks associated with deviation from medical norms and established practices;

and (v) the patient signs and acknowledges a notice of deviation;

and (g) before providing an alternative health care service, the health care provider discloses to the patient that the patient may enter into an agreement describing what would constitute the health care provider's negligence related to deviation.

(6) As used in this section, "notice of deviation" means a written notice provided by a health care provider to a patient that:

(a) is specific to the patient;

(b) indicates that the health care provider is deviating from medical norms or established practices in the health care provider's recommendation for the patient's treatment;

(c) describes how the alternative health care service deviates from medical norms or established practices;

(d) describes the potential risks and benefits associated with the alternative health care service;

(e) describes the health care provider's reasonably justified rationale regarding the reason for the deviation;

and (f) provides clear and unequivocal notice to the patient that the patient is agreeing to receive the alternative health care service which is outside medical norms and established practices.

{Section 5.

Section 58-1-502 is amended to read:

} 58-1-502.

Unlawful and unprofessional conduct -- Penalties.

(1) (a) Unless otherwise specified in this title, a person who violates the unlawful conduct provisions defined in this title is guilty of a class A misdemeanor.

(b) Unless a specific fine amount is specified elsewhere in this title, the director or the director's designee may assess an administrative fine of up to $1,000 for each instance of unprofessional or unlawful conduct defined in this title.

(2) (a) In addition to any other statutory penalty for a violation related to a specific occupation or profession regulated by this title, if upon inspection or investigation, the division concludes that a - 18 - HB0071 compared with HB0071S04 person has violated Subsection 58-1-501(1)(a), (1)(c), (1)(g), [or] (2)(a)(xv), or (2)(a)(xvii), or a rule or order issued with respect to those subsections, and that disciplinary action is appropriate, the director or the director's designee from within the division shall promptly:

(i) issue a citation to the person according to this section and any pertinent rules;

(ii) attempt to negotiate a stipulated settlement;

or (iii) notify the person to appear before an adjudicative proceeding conducted under Title 63G, Chapter 4, Administrative Procedures Act.

(b) (i) The division may assess a fine under this Subsection (2) against a person who violates Subsection 58-1-501(1)(a), (1)(c), (1)(g), [or] (2)(a)(xv), or (2)(a)(xvii), or a rule or order issued with respect to those subsections, as evidenced by:

(A) an uncontested citation;

(B) a stipulated settlement;

or (C) a finding of a violation in an adjudicative proceeding.

(ii) The division may, in addition to or in lieu of a fine under Subsection (2)(b)(i), order the person to cease and desist from violating Subsection 58-1-501(1)(a), (1)(c), (1)(g), [or] (2)(a)(xv), or (2)(a) (xvii), or a rule or order issued with respect to those subsections.

(c) Except for a cease and desist order, the division may not assess the licensure sanctions cited in Section 58-1-401 through a citation.

(d) A citation shall:

(i) be in writing;

(ii) describe with particularity the nature of the violation, including a reference to the provision of the chapter, rule, or order alleged to have been violated;

(iii) clearly state that the recipient must notify the division in writing within 20 calendar days of service of the citation if the recipient wishes to contest the citation at a hearing conducted under Title 63G, Chapter 4, Administrative Procedures Act;

and (iv) clearly explain the consequences of failure to timely contest the citation or to make payment of a fine assessed by the citation within the time specified in the citation.

(e) The division may issue a notice in lieu of a citation.

(f) - 19 - HB0071 compared with HB0071S04 (i) If within 20 calendar days from the service of the citation, the person to whom the citation was issued fails to request a hearing to contest the citation, the citation becomes the final order of the division and is not subject to further agency review.

(ii) The period to contest a citation may be extended by the division for cause.

(g) The division may refuse to issue or renew, suspend, revoke, or place on probation the license of a licensee who fails to comply with a citation after it becomes final.

(h) The failure of an applicant for licensure to comply with a citation after it becomes final is a ground for denial of license.

(i) Subject to the time limitations described in Subsection 58-1-401(6), the division may not issue a citation under this section after the expiration of one year following the date on which the violation that is the subject of the citation is reported to the division.

(j) The director or the director's designee shall assess fines according to the following:

(i) for the first offense handled pursuant to Subsection (2)(a), a fine of up to $1,000;

(ii) for a second offense handled pursuant to Subsection (2)(a), a fine of up to $2,000;

and (iii) for each subsequent offense handled pursuant to Subsection (2)(a), a fine of up to $2,000 for each day of continued offense.

(3) (a) An action for a first or second offense that has not yet resulted in a final order of the division may not preclude initiation of a subsequent action for a second or subsequent offense during the pendency of a preceding action.

(b) The final order on a subsequent action is considered a second or subsequent offense, respectively, provided the preceding action resulted in a first or second offense, respectively.

(4) (a) The director may collect a penalty that is not paid by:

(i) referring the matter to a collection agency;

or (ii) bringing an action in the district court of the county where the person against whom the penalty is imposed resides or in the county where the office of the director is located.

(b) A county attorney or the attorney general of the state shall provide legal assistance and advice to the director in an action to collect a penalty.

(c) A court may award reasonable attorney fees and costs to the prevailing party in an action brought by the division to collect a penalty.

- 20 - HB0071 compared with HB0071S04 Section 4.

63I-2-258.63I-2-258 .

[Reserved.]Section[Reserved.] Section 58-1-113, Statewide behavioral health provider database study, is repealed July 1, 2027.

Effective date.

2-25-26 9:02 PM - 2112 -