1. (1) With respect to a health insurance policy or managed care organization contract that does not allow an insured to have direct access to a health care specialist, the insurer shall establish and implement a procedure by which an insured may obtain a standing referral to a health care specialist.

2. (2) The procedure established under Subsection (1):

   1. (a) shall provide for a standing referral to a specialist if the insured's primary care provider determines, in consultation with the specialist, that the insured needs continuing care from the specialist; and

   2. (b) may require the insurer's approval of a treatment plan designed by the specialist, in consultation with the primary care provider and the insured, which may include:

      1. (i) a limit on the number of visits to the specialist;
      2. (ii) a time limit on the duration of the referral; and
      3. (iii) mandatory updates on the insured's condition.

Amended by Chapter 292, 2017 General Session