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27-1-10.1
Section 27-1-10.1 Insurance coverage for drugs to treat life-threatening illnesses. (a) The
Legislature finds and declares the following: (1) The citizens of this state rely upon health
insurance to cover the cost of obtaining health care and it is essential that the citizens'
expectation that their health care costs will be paid by their insurance policies is not disappointed
and that they obtain the coverage necessary and appropriate for their care within the terms
of their insurance policies. (2) Some insurers deny payment for drugs that have been approved
by the Federal Food and Drug Administration, hereafter referred to as FDA, when the drugs
are used for indications other than those stated in the labelling approved by the FDA, off-label
use, while other insurers with similar coverage terms do pay for off-label use. (3) Denial
of payment for off-label use can interrupt or effectively deny access to necessary and appropriate
treatment for a person being treated for a...
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34-22-83
Section 34-22-83 Telemedicine - Services; provider-patient relationship; standards of practice;
confidentiality. (a) Telemedicine services provided at an established treatment site may be
used for all patient visits, including initial evaluations to establish a proper doctor-patient
relationship between a provider and a patient. (1) A provider shall be reasonably available
onsite at the established medical site to assist with the provision of care. (2) A provider
may delegate tasks and activities at an established treatment site to an assistant who is
properly trained and supervised or directed. (b) A distant site provider who provides telemedicine
services to a patient that is not present at an established treatment site shall ensure that
a proper provider-patient relationship is established, which at a minimum includes all of
the following: (1) Having had at least one face-to-face meeting at an established treatment
site before engaging in telemedicine services. A face-to-face...
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34-9-6.1
Section 34-9-6.1 Mobile dental facilities or portable dental operations. (a) For purposes of
this section, the following words have the following meanings: (1) DENTAL HOME. The dental
home is the ongoing relationship between the dentist and the patient, inclusive of all aspects
of oral health care, delivered in a comprehensive, continuously accessible, coordinated, and
family-centered way. (2) MOBILE DENTAL FACILITY. Any self-contained facility in which dentistry
or dental hygiene is practiced which may be moved, towed, or transported from one location
to another. (3) OPERATOR. A person licensed to practice dentistry in this state or an entity
which is approved as tax exempt under Section 501(c)(3) of the Internal Revenue Code which
employs dentists licensed in the state to operate a mobile dental facility or portable dental
operation. (4) PORTABLE DENTAL OPERATION. The use of portable dental delivery equipment which
is set up on site to provide dental services outside of a mobile...
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22-21-260
Section 22-21-260 Definitions. As used in this article, the following words and terms, and
the plurals thereof, shall have the meanings ascribed to them in this section, unless otherwise
required by their respective context: (1) ACQUISITION. Obtaining the legal equitable title
to a freehold or leasehold estate or otherwise obtaining the substantial benefit of such titles
or estates, whether by purchase, lease, loan or suffrage, gift, devise, legacy, settlement
of a trust or means whatever, and shall include any act of acquisition. The term "acquisition"
shall not mean or include any conveyance, or creation of any lien or security interest by
mortgage, deed of trust, security agreement, or similar financing instrument, nor shall it
mean or include any transfer of title or rights as a result of the foreclosure, or conveyance
or transfer in lieu of the foreclosure, of any such mortgage, deed of trust, security agreement,
or similar financing instrument, nor shall it mean or include any...
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27-54-2
Section 27-54-2 Definitions. For purposes of this chapter, the following terms have the following
meanings: (1) DAY TREATMENT SERVICES. Includes, but is not limited to: Physiological, psychological,
and psychosocial concepts, techniques, and processes necessary to maintain or develop functional
skills of clients, provided to individuals and groups for periods of more than two hours but
less than 24 hours a day. (2) HEALTH BENEFIT PLAN. A health care service plan governed by
the provisions of Article 6, Chapter 4, Title 10, and a group health insurance policy, including
an employee welfare health benefit plan, that covers hospital, medical, or surgical expenses,
issued by insurers, health maintenance organizations, preferred provider organizations, medical
service organizations, physician-hospital organizations, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for, purchases, or furnishes health
care services to patients, insureds, or...
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34-25A-4
Section 34-25A-4 Referral and consultation limits. (a) A licensed prosthetist, licensed orthotist,
or licensed prosthetist/orthotist may provide services utilizing new prostheses or orthoses
for which he or she is licensed and only under a written order from an authorized health care
practitioner. A consultation with and periodic review by an authorized health care practitioner
is not required for the evaluation, repair, adjusting, or servicing of a prosthesis by a licensed
prosthetist, or licensed prosthetist/orthotist and for the evaluation, repair, adjusting,
or servicing of an orthosis by a licensed orthotist, or licensed prosthetist/orthotist; nor
is an order from an authorized health care practitioner required for maintenance or replacement
of an orthosis or prosthesis to the level of its original prescription for an indefinite period
of time if the original order remains appropriate for the patient's medical needs. (b) Prosthetists
and orthotists must refer persons receiving...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant to
this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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27-3A-5
Section 27-3A-5 Standards for utilization review agents. (a) Except as provided in subsection
(b), all utilization review agents shall meet the following minimum standards: (1) Notification
of a determination by the utilization review agent shall be mailed or otherwise communicated
to the provider of record or the enrollee or other appropriate individual within two business
days of the receipt of the request for determination and the receipt of all information necessary
to complete the review. (2) Any determination by a utilization review agent as to the necessity
or appropriateness of an admission, service, or procedure shall be reviewed by a physician
or determined in accordance with standards or guidelines approved by a physician. (3) Any
notification of determination not to certify an admission, service, or procedure shall include
the principal reason for the determination and the procedures to initiate an appeal of the
determination. (4) Utilization review agents shall maintain...
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22-18-6
Section 22-18-6 Violations; good Samaritan provisions; scope of privilege; control of emergency
scene; penalties. (a) It shall be a Class A misdemeanor for any person, firm, company, corporation,
organization, facility, or agency to do any of the following: (1) Deliberately hinder, obstruct,
or interfere with an officer, inspector, or duly authorized agent of the board while in the
performance of official duties. (2) Deliberately hinder, obstruct, or interfere with any physician,
licensed nurse, licensed EMSP, or emergency personnel exempt from licensure under this article
while that individual is providing emergency care to a third person or while that individual
is assisting at the scene of an emergency, directing traffic at the scene of an emergency,
or managing or helping to manage the scene of an emergency. (3) Violate subsection (c) or
(d). (4) Offer, provide, or perform, without a license or certificate to do so, an emergency
medical service or other function which, under this...
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34-24-125
Section 34-24-125 Chiropractic agreements. (a) For the purposes of this section, the following
words shall have the following meanings: (1) CHIROPRACTOR. A person licensed to practice chiropractic
in this state. (2) CHIROPRACTIC AGREEMENT or AGREEMENT. A contract between a chiropractor
and a patient or his or her legal representative in which the chiropractor or the chiropractor's
chiropractic practice agrees to provide chiropractic services to the patient for an agreed
upon fee and period of time. (3) CHIROPRACTIC PRACTICE. A chiropractor or a chiropractic practice
of a chiropractor that charges a periodic fee for chiropractic services and which does not
bill a third party any additional fee for services for patients covered under a chiropractic
agreement. The per visit charge of the practice shall be less than the monthly equivalent
of the periodic fee. (b) A chiropractic agreement is not insurance, may not be deemed an insurance
arrangement, and is not subject to state insurance...
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