Utah Labor Codes 34A-2-111 11

(a) (i) A preferred provider program may be developed so long as the program allows a selection by the employee of more than one physician in the health care specialty required for treating the specific problem of an industrial patient. If a preferred provider program is developed by an employer, insurance carrier, or self-insured entity, employees are required to use preferred provider physicians and medical care facilities. If a preferred provider program is not developed, an industrial claimant may have free choice of health care providers. Failure of an industrial claimant to use a preferred health care facility as defined in Section 26-21-2 as part of a preferred provider program, or failure to initially receive treatment from a preferred physician, may, if the claimant has been notified of the program, result in the claimant being obligated for any charges in excess of the preferred provider allowances. (ii) Notwithstanding the requirements of Subsection (1)(a)(i), a self-insured entity or other employer may: (A) have its own health care facility on or near its worksite or premises and continue to contract with other health care providers; or (B) operate a health care facility and require employees to first seek treatment at the provided health care or contracted facility. (iii) An employee of an employer using a preferred provider program or having its own health care facility may procure the services of any qualified practitioner: (A) for emergency treatment, if a physician employed in the program or at the facility is not available for any reason; (B) for conditions the employee in good faith believes are nonindustrial; or (C) when an employee living in a rural area would be unduly burdened by traveling to a preferred provider. (b) (i) Other contracts with medical care providers or medical review organizations may be made for the following purposes: (A) insurance carriers or self-insured employers may form groups in contracting for managed health care services with medical providers; (B) peer review; (C) methods of utilization review; (D) use of case management; and (E) bill audit. (ii) Insurance carriers may make any or all of the factors in Subsection (1)(b)(i) a condition of insuring entities in their insurance contract. (2) As used in Subsection (1), "physician" means any health care provider licensed under:(a) Title 58, Chapter 5a, Podiatric Physician Licensing Act; (b) Title 58, Chapter 24a, Physical Therapist Practice Act; (c) Title 58, Chapter 67, Utah Medical Practice Act; (d) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act; (e) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act; (f) Title 58, Chapter 70, Physician Assistant Practice Act;

(g) Title 58, Chapter 71, Naturopathic Physician Practice Act; (h) Title 58, Chapter 72, Acupuncture Licensing Act; and (i) Title 58, Chapter 73, Chiropractic Physician Practice Act. (3) Each workers' compensation insurance carrier writing insurance in this state shall maintain a designated agent in this state registered with the division. (4) (a) In addition to managed health care plans, an insurance carrier may require an employer to establish a work place safety program if the employer: (i) has an experience modification factor of 1.00 or higher, as determined by the National Council on Compensation Insurance; or (ii) is determined by the carrier to have a three-year loss ratio of 100% or higher. (b) A workplace safety program may include: (i) a written workplace accident and injury reduction program that promotes safe and healthful working conditions, which is based on clearly stated goals and objectives for meeting those goals; and (ii) a documented review of the workplace accident and injury reduction program each calendar year delineating how procedures set forth in the program are met. (5) A written workplace accident and injury reduction program permitted under Subsection (4)(b)(i) should describe: (a) how managers, supervisors, and employees are responsible for implementing the program; (b) how continued participation of management will be established, measured, and maintained; (c) the methods used to identify, analyze, and control new or existing hazards, conditions, and operations; (d) how the program will be communicated to all employees so that the employees are informed of work-related hazards and controls; (e) how workplace accidents will be investigated and corrective action implemented; and (f) how safe work practices and rules will be enforced. (6) The premiums charged to any employer who fails or refuses to establish a workplace safety program pursuant to Subsection (4)(b)(i) or (ii) may be increased by 5% over any existing current rates and premium modifications charged that employer.

Renumbered and Amended by Chapter 375, 1997 General Session