H-1140.1 _______________________________________________
HOUSE BILL 1498
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State of Washington 55th Legislature 1997 Regular Session
By Representatives Van Luven, Dyer, Murray, Wood, Zellinsky, Backlund and Skinner
Read first time 01/28/97. Referred to Committee on Health Care.
AN ACT Relating to utilization reviews of services provided by mental health practitioners; and adding a new section to chapter 48.43 RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. A new section is added to chapter 48.43 RCW to read as follows:
(1) A person performing a utilization review of services provided by a mental health practitioner for a health carrier or lawful third party payer is limited to access to the records of persons covered by the specific health carrier or lawful third party payer for which the review is performed.
(2) For purposes of this section:
(a) "Health carrier" means a health carrier as defined in RCW 48.43.005(8);
(b) "Lawful third party payer" means a third party payer that is operating lawfully under state or federal law and may include public or private third party payers, including by way of illustration and not limitation, public or private insuring entities regulated pursuant to this title, health care coverage programs of the government of the state of Washington under chapter 41.05, 70.47, or 74.09 RCW; health care coverage programs of local governmental units pursuant to chapter 48.62 RCW; any industrial insurance programs under Title 51 RCW; private self-insured employer welfare benefit plans exempt from state insurance regulation by federal law; and the federal government as to any of its health care programs such as medicare, CHAMPUS, or other coverage for federal employees and dependents;
(c) "Mental health practitioner" means a physician licensed under chapter 18.57 or 18.71 RCW who provided mental health services, an advanced practice psychiatric nurse authorized by the nursing quality care assurance commission under chapter 18.79 RCW, a psychologist licenced under chapter 18.83 RCW, or a social worker, marriage and family therapist, or mental health counselor certified under chapter 18.19 RCW; and
(d) "Utilization review" means a set of formal techniques, such as those developed by the utilization review accreditation commission, designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficiency, or effectiveness of, mental health services.
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