H-4854.1  _______________________________________________

                    SUBSTITUTE HOUSE BILL 2701

          _______________________________________________

State of Washington      55th Legislature     1998 Regular Session

By House Committee on Health Care (originally sponsored by Representatives Van Luven, Cody, Skinner, Anderson, Dyer, Ogden, Dickerson, Mason and Wood)

Read first time 02/03/98.  Referred to Committee on .

Establishing utilization review and disclosure standards for outpatient mental health services.

    AN ACT Relating to establishing utilization review and disclosure standards for outpatient mental health services; 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) Every health carrier that provides coverage for any outpatient mental health service shall comply with the following requirements:

    (a) In performing a utilization review of mental health services for a specific enrollee, the person performing the utilization review is limited to accessing only the specific health care information for the particular enrollee in question that is necessary to complete the review.

    (b) In performing an audit of mental health services, the person performing the audit is limited to accessing only the records of persons covered by the specific health carrier for which the audit is being performed, except as otherwise permitted by RCW 70.02.050 and 71.05.630.

    (c) When making disclosures in benefit booklets and any other information given to prospective and current enrollees that describes their mental health benefits, the following information must be included:

    (i) If mental health services are managed, and how an enrollee can obtain the name of the entity through which a health carrier performs that function;

    (ii) Any preauthorization requirements;

    (iii) Restrictions, other than those based on medical necessity, on accessing the specified number of visits included in a particular plan;

    (iv) If a particular treatment modality or theoretical approach is required by the health carrier to be used for a majority of the enrollees;

    (v) Information as to any categories of mental health conditions or diagnoses that are excluded from coverage; and

    (vi) What safeguards will be used by the health carrier and utilization review personnel to protect the confidentiality of mental health patient records.

    (2) A health carrier is responsible for the implementation of this section, whether it manages and delivers outpatient mental health services itself, or whether it contracts with another entity.

    (3) This section is applicable to health carrier health benefit plans issued or renewed on or after January 1, 1999.

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