BP BHEAD INT S [atlas:bill]

AN ACT Relating to health care and health insurance benefits for physical injuries resulting from suicide attempts; amending RCW 48.41.110 and 74.09.520; 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; creating a new section; and providing an effective date.

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

NEW SECTION. Sec. 1. The legislature finds that the health and well-being of our citizens are critically important to the public welfare. The legislature further finds that suicide is a significant cause of death in the United States. Attempted suicide is usually a symptom indicating that a person is experiencing stressful or traumatic events that push their normal coping strategies to the limit. This distress leaves them feeling terribly isolated and that there are no other options. The legislature further finds that suicidal people often fail to receive the care needed to help them heal. This lack of adequate coverage can have a detrimental effect and can result in long-term emotional and physical damage. It is the intent of the legislature to help people who attempt suicide recover by ensuring that they receive health care coverage to treat their self-imposed physical damage.

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

(1) Every health plan offered to public employees and their covered dependents under this chapter that is not subject to the provisions of Title 48 RCW and is established or renewed after the effective date of this act, and that provides benefits for hospital or medical care shall provide benefits for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) Subsection (1) of this section does not prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions.

(3) Every public employee covered under this chapter must be notified of the required coverage under subsection (1) of this section in an annual summary of benefits or by other written notice no later than January 1, 1999, whichever occurs first.

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

(1) Every disability insurance policy issued or renewed after the effective date of this act, that provides benefits for hospital or medical care shall provide benefits for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) Subsection (1) of this section does not prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions

(3) Every individual covered under this chapter must be notified of the required coverage under subsection (1) of this section in an annual summary of benefits or by other written notice no later than January 1, 1999, whichever occurs first.

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

(1) Every group disability insurance policy issued or renewed after the effective date of this act, that provides benefits for hospital or medical care shall provide benefits for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) Subsection (1) of this section does not prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions

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

(1) Every health care service contract issued or renewed after the effective date of this act, that provides benefits for hospital or medical care shall provide benefits for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) Subsection (1) of this section does not prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions.

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

(1) Every health maintenance agreement issued or renewed after the effective date of this act, that provides benefits for hospital or medical care shall provide benefits for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) Subsection (1) of this section does not prevent the application of standard health plan provisions applicable to other benefits such as deductible or copayment provisions.

Sec. 7. RCW 48.41.110 and 1997 c 231 s 213 are each amended to read as follows:

(1) The pool is authorized to offer one or more managed care plans of coverage. Such plans may, but are not required to, include point of service features that permit participants to receive in-network benefits or out-of-network benefits subject to differential cost shares. Covered persons enrolled in the pool on January 1, 1997, may continue coverage under the pool plan in which they are enrolled on that date. However, the pool may incorporate managed care features into such existing plans.

(2) The administrator shall prepare a brochure outlining the benefits and exclusions of the pool policy in plain language. After approval by the board of directors, such brochure shall be made reasonably available to participants or potential participants. The health insurance policy issued by the pool shall pay only usual, customary, and reasonable charges for medically necessary eligible health care services rendered or furnished for the diagnosis or treatment of illnesses, injuries, and conditions which are not otherwise limited or excluded. Eligible expenses are the usual, customary, and reasonable charges for the health care services and items for which benefits are extended under the pool policy. Such benefits shall at minimum include, but not be limited to, the following services or related items:

(a) Hospital services, including charges for the most common semiprivate room, for the most common private room if semiprivate rooms do not exist in the health care facility, or for the private room if medically necessary, but limited to a total of one hundred eighty inpatient days in a calendar year, and limited to thirty days inpatient care for mental and nervous conditions, or alcohol, drug, or chemical dependency or abuse per calendar year;

(b) Professional services including surgery for the treatment of injuries, illnesses, or conditions, other than dental, which are rendered by a health care provider, or at the direction of a health care provider, by a staff of registered or licensed practical nurses, or other health care providers;

(c) The first twenty outpatient professional visits for the diagnosis or treatment of one or more mental or nervous conditions or alcohol, drug, or chemical dependency or abuse rendered during a calendar year by one or more physicians, psychologists, or community mental health professionals, or, at the direction of a physician, by other qualified licensed health care practitioners, in the case of mental or nervous conditions, and rendered by a state certified chemical dependency program approved under chapter 70.96A RCW, in the case of alcohol, drug, or chemical dependency or abuse;

(d) Drugs and contraceptive devices requiring a prescription;

(e) Services of a skilled nursing facility, excluding custodial and convalescent care, for not more than one hundred days in a calendar year as prescribed by a physician;

(f) Services of a home health agency;

(g) Chemotherapy, radioisotope, radiation, and nuclear medicine therapy;

(h) Oxygen;

(i) Anesthesia services;

(j) Prostheses, other than dental;

(k) Durable medical equipment which has no personal use in the absence of the condition for which prescribed;

(l) Diagnostic x-rays and laboratory tests;

(m) Oral surgery limited to the following: Fractures of facial bones; excisions of mandibular joints, lesions of the mouth, lip, or tongue, tumors, or cysts excluding treatment for temporomandibular joints; incision of accessory sinuses, mouth salivary glands or ducts; dislocations of the jaw; plastic reconstruction or repair of traumatic injuries occurring while covered under the pool; and excision of impacted wisdom teeth;

(n) Maternity care services, as provided in the managed care plan to be designed by the pool board of directors, and for which no preexisting condition waiting periods may apply;

(o) Services of a physical therapist and services of a speech therapist;

(p) Hospice services;

(q) Professional ambulance service to the nearest health care facility qualified to treat the illness or injury; ((~~and~~))

(r) Other medical equipment, services, or supplies required by physician's orders and medically necessary and consistent with the diagnosis, treatment, and condition; and

(s) Hospital or medical care for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(3) The board shall design and employ cost containment measures and requirements such as, but not limited to, care coordination, provider network limitations, preadmission certification, and concurrent inpatient review which may make the pool more cost-effective.

(4) The pool benefit policy may contain benefit limitations, exceptions, and cost shares such as copayments, coinsurance, and deductibles that are consistent with managed care products, except that differential cost shares may be adopted by the board for nonnetwork providers under point of service plans. The pool benefit policy cost shares and limitations must be consistent with those that are generally included in health plans approved by the insurance commissioner; however, no limitation, exception, or reduction may be used that would exclude coverage for any disease, illness, or injury.

(5) The pool may not reject an individual for health plan coverage based upon preexisting conditions of the individual or deny, exclude, or otherwise limit coverage for an individual's preexisting health conditions; except that it may impose a three-month benefit waiting period for preexisting conditions for which medical advice was given, or for which a health care provider recommended or provided treatment, within three months before the effective date of coverage. The pool may not avoid the requirements of this section through the creation of a new rate classification or the modification of an existing rate classification.

Sec. 8. RCW 74.09.520 and 1995 1st sp.s. c 18 s 39 are each amended to read as follows:

(1) The term "medical assistance" may include the following care and services: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and x-ray services; (d) nursing facility services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary; (g) home health care services; (h) private duty nursing services; (i) dental services; (j) physical and occupational therapy and related services; (k) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; (l) personal care services, as provided in this section; (m) hospice services; (n) other diagnostic, screening, preventive, and rehabilitative services; and (o) like services when furnished to a child by a school district in a manner consistent with the requirements of this chapter. For the purposes of this section, the department may not cut off any prescription medications, oxygen supplies, respiratory services, or other life-sustaining medical services or supplies.

"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services.

"Medical assistance" also includes hospital or medical care for self-inflicted physical injuries, including those caused by the intentional overdose of drugs or other chemical substances, that are the result of a suicide attempt.

(2) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.

(3) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.

(a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.

(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care must be reviewed by a nurse.

(4) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.

(5) The department shall report to the appropriate fiscal committees of the legislature on the utilization and associated costs of the personal care option under Title XIX of the federal social security act, as defined in 42 C.F.R. 440.170(f), in the categorically needy program. This report shall be submitted by January 1, 1990, and submitted on a yearly basis thereafter.

(6) Effective July 1, 1989, the department shall offer hospice services in accordance with available funds.

(7) For Title XIX personal care services administered by aging and adult services administration of the department, the department shall contract with area agencies on aging:

(a) To provide case management services to individuals receiving Title XIX personal care services in their own home; and

(b) To reassess and reauthorize Title XIX personal care services or other home and community services ((~~as defined in RCW 74.39A.008~~)) in home or in other settings for individuals consistent with the intent of this section:

(i) Who have been initially authorized by the department to receive Title XIX personal care services or other home and community services ((~~as defined in RCW 74.39A.008~~)); and

(ii) Who, at the time of reassessment and reauthorization, are receiving such services in their own home.

(8) In the event that an area agency on aging is unwilling to enter into or satisfactorily fulfill a contract to provide these services, the department is authorized to:

(a) Obtain the services through competitive bid; and

(b) Provide the services directly until a qualified contractor can be found.

NEW SECTION. Sec. 9. This act takes effect July 1, 1998.