Washington State House of Representatives Office of Program Research	BILL ANALYSIS
Health Care Committee

HB 1364

Brief Description:  Mandating general anesthesia services.

Sponsors:  Representatives Pflug, Edmonds, Cody, Campbell, Boldt, Doumit, Pennington and Schual‑Berke.

Brief Summary of Bill

$Provides a mandated health benefit of general anesthesia for public employees covered by comprehensive health care provided under the state Health Care Authority, and for persons covered by health carriers.

Hearing Date:  2/15/01

Staff:  John Welsh (786‑7133).

Background: 

There is no mandated offering or benefit for the medical procedure of general anesthesia required by law to be covered in public employee benefit plans under the State Health Authority, or to persons covered by health carriers.  Public employee benefit plans include state employees, employees of higher education, community colleges, retirees of public schools (K through 12); and all other local political jurisdictions that opt for coverage for their employees.  Health carriers include disability insurers, health care service contractors, and health maintenance organizations.

Anesthesia is a medical procedure for inducing a state of unconsciousness in a patient.

Summary of Bill: 

General anesthesia is defined as a state of unconsciousness accompanied by a loss of protected reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command.

Public employee benefit plans and health carriers that offer hospital, medical, or ambulatory surgery services must cover hospital and general anesthesia services in conjunction with dental procedures performed in a hospital or surgery center under certain conditions.  The procedure must be for a person under the age of seven for a dental procedure that cannot be safely performed in a dental office, and the treatment must be recommended by the person=s physician. The child must be physically or developmentally disabled or have at least one medical condition that would create an undue medical risk if not performed in a hospital or surgery center.

Health carriers that offer dental services must cover general anesthesia services in conjunction with dental procedures under certain conditions.  The procedure must be for a person under the age of seven who is physically or developmentally disabled and the procedure can safely be performed in a dental office.  Prior authorization, cost-sharing, and participating health care facility requirements may apply.  The authority to negotiate rates and contracts with providers is not limited.  This procedure is not covered under any Medicare supplement policies nor any supplemental contracts for a specific disease.

This requirement becomes effective for health insurance plans issued or renewed after the effective date of this act.

Appropriation:  None.

Fiscal Note:  Requested on February 13, 2001.

Effective Date:  Ninety days after adjournment of session in which bill is passed.