S-4475.1 _______________________________________________
SENATE BILL 6575
_______________________________________________
State of Washington 53rd Legislature 1994 Regular Session
By Senators McCaslin, Fraser, Nelson, West and Roach
Read first time 01/31/94. Referred to Committee on Health & Human Services.
AN ACT Relating to the uniform benefits package schedule of covered health services; and amending RCW 43.72.130.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 43.72.130 and 1993 c 492 s 449 are each amended to read as follows:
(1) The commission shall define the uniform benefits package, which shall include those health services that, consistent with the goals and intent of chapter 492, Laws of 1993, are effective and necessary on a societal basis for the maintenance of the health of citizens of the state, weighed against the need to control state health services expenditures.
(2) The schedule of
covered health services shall emphasize proven preventive and primary health
care and shall be composed of the following essential health services: (a)
Primary and specialty health services; (b) inpatient and outpatient hospital
services; (c) prescription drugs and medications; (d) reproductive services;
(e) services necessary for maternity and well-child care, including preventive
dental services for children; ((and)) (f) physical therapy,
rehabilitative, and physical medicine; and (g) case-managed chemical
dependency, mental health, short-term skilled nursing facility, home health,
and hospice services, to the extent that such services reduce inappropriate
utilization of more intensive or less efficacious medical services. The
commission shall determine the specific schedule of health services within the
uniform benefits package, including limitations on scope and duration of
services. The schedule shall be the benefit and actuarial equivalent of the
schedule of benefits offered by the basic health plan on January 1, 1993, including
any additions that may result from the inclusion of the services listed in (c)
through (f) of this subsection. The commission shall consider the
recommendations of health services effectiveness panels [committee] established
pursuant to RCW 43.72.060 in defining the uniform benefits package.
(3) The uniform benefits package shall not limit coverage for preexisting or prior conditions, except that the commission shall establish exclusions for preexisting or prior conditions to the extent necessary to prevent residents from waiting until health services are needed before enrolling in a certified health plan.
(4) The commission shall establish enrollee point of service cost-sharing for nonpreventive health services, related to enrollee household income, such that financial considerations are not a barrier to access for low-income persons, but that, for those of means, the uniform benefits package provides for moderate point of service cost-sharing. All point of service cost-sharing and cost control requirements shall apply uniformly to all health care providers providing substantially similar uniform benefits package services. The schedule shall provide for an alternate and lower schedule of cost-sharing applicable to enrollees with household income below the federal poverty level.
(5) The commission shall adopt rules related to coordination of benefits and premium payments. The rules shall not have the effect of eliminating enrollee financial participation. The commission shall endeavor to assure an equitable distribution, among both employers and employees, of the costs of coverage for those households composed of more than one member in the work force.
(6) In determining the uniform benefits package, the commission shall endeavor to seek the opinions of and information from the public. The commission shall consider the results of official public health assessment and policy development activities including recommendations of the department of health in discharging its responsibilities under this section.
(7) The commission shall submit the following to the legislature by December 1, 1994, and by December 1 of the year preceding any year in which the commission proposes to significantly modify the uniform benefits package: (a) The uniform benefits package; and (b) an independent actuarial analysis of the cost of the proposed package, giving consideration to the factors considered under RCW 43.72.040(6). The commission shall not modify the services included in the uniform benefits package before January 1, 1999.
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