6468-S

AN ACT Relating to coverage for cranial hair prostheses for alopecia areata; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. (1) The legislature finds the following:

(a) Alopecia areata and its variants, alopecia totalis and alopecia universalis, are common, noncontagious diseases that affect an estimated two million Americans. They are diseases of the hair follicle with results ranging from large patches of baldness to the total loss of all body hair. This hair loss can be acute and short-lived, occurring in just days or weeks, or chronic with years of regrowth in some sites and progression to new sites.

(b) Alopecia areata and its variants are associated with an alteration in the immunological system, but their cause is unknown.

(c) Treatments for alopecia areata, totalis, and universalis using immunomodulating agents can stimulate new hair growth, but none prevent new patches from developing. These treatments must be continued to maintain their effect, but treatment for alopecia areata may stop when the disease goes into spontaneous remission. There are concerns surrounding the long-term use and side effects of some of the treatments.

(d) Patients with alopecia areata, totalis, and universalis may suffer a profound alteration in their functional status, particularly women and children. There are documented cases of adults who have lost their jobs, have been harassed, and have been accused of belonging to extremist cults because of their appearance due to hair loss. Children with alopecia areata, totalis, or universalis have been removed from mainstream classes and placed in special education classes and ostracized by their peers.

(e) Alopecia areata, totalis, and universalis are recognized medical disease processes, which cause severe hair loss that can alter a patient's functional status. The use of cranial hair protheses returns patients to their previous functional status.

(2) It is the intent of the legislature to clarify that policies that provide benefits for prostheses must provide benefits for cranial hair prostheses for alopecia areata, totalis, or universalis.

NEW SECTION. Sec. 2. A new section is added to chapter 41.05 RCW to read as follows:

All state-purchased health care that provides coverage for prostheses shall include coverage for cranial hair prostheses for patients suffering from alopecia areata, totalis, or universalis, to the extent that benefits are provided for alopecia areata, totalis, or universalis, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.

This section shall not be construed to prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions. This section does not limit the authority of the state health care authority to negotiate rates and contract with specific providers for the delivery of prostheses. This section does not apply to medicare supplement policies or supplemental contracts covering a specified disease or other limited benefits.

NEW SECTION. Sec. 3. A new section is added to chapter 48.20 RCW to read as follows:

An insurer that offers to any individual a health benefit plan that provides coverage for prostheses shall include coverage for cranial hair prostheses for patients suffering from alopecia areata, totalis, or universalis, to the extent that benefits are provided for alopecia areata, totalis, or universalis, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.

NEW SECTION. Sec. 4. A new section is added to chapter 48.21 RCW to read as follows:

A group insurance contract or blanket disability insurance contract that provides coverage for prostheses shall include coverage for cranial hair prostheses for patients suffering from alopecia areata, totalis, or universalis, to the extent that benefits are provided for alopecia areata, totalis, or universalis, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.

NEW SECTION. Sec. 5. A new section is added to chapter 48.44 RCW to read as follows:

A health service contractor that provides coverage for prostheses shall include coverage for cranial hair prostheses for patients suffering from alopecia areata, totalis, or universalis, to the extent that benefits are provided for alopecia areata, totalis, or universalis, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.

NEW SECTION. Sec. 6. A new section is added to chapter 48.46 RCW to read as follows:

A health maintenance organization that provides coverage for prostheses shall include coverage for cranial hair prostheses for patients suffering from alopecia areata, totalis, or universalis, to the extent that benefits are provided for alopecia areata, totalis, or universalis, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.