S-3891.1 _______________________________________________
SENATE BILL 6405
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State of Washington 55th Legislature 1998 Regular Session
By Senators Strannigan, Fairley and Winsley
Read first time 01/19/98. Referred to Committee on Health & Long‑Term Care.
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 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. Necessary information for the enrollee means only the symptoms, diagnoses, and treatment plan relevant to the mental health diagnosis.
(b) In performing an audit of 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. Accessible records include information related only to the symptoms, diagnoses, and treatment plans relevant to the mental health diagnosis.
(c) When making disclosures in benefit booklets and any other information given to prospective and current enrollees that describes their benefits, the following information must be included:
(i) How 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 on accessing the number of visits included in a particular plan;
(iv) Preferred treatment modality or theoretical approach upon which the benefit may be based;
(v) Information as to any mental health conditions or diagnoses that are excluded from coverage; and
(vi) What safeguards will be used 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.
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