SENATE BILL REPORT

SSB 5099

As Passed Senate, January 30, 2002

Title:  An act relating to the designation of licensed dental directors by carriers offering dental only coverage.

Brief Description:  Designating medical directors.

Sponsors:  Senate Committee on Health & Long‑Term Care (originally sponsored by Senators Winsley and Thibaudeau).

Brief History:

Committee Activity:  Health & Long‑Term Care:  1/24/01, 2/14/01 [DPS].

Passed Senate:  3/10/01, 48-0; 1/30/02, 47-0.

SENATE COMMITTEE ON HEALTH & LONG‑TERM CARE

Majority Report:  That Substitute Senate Bill No. 5099 be substituted therefor, and the substitute bill do pass.

Signed by Senators Thibaudeau, Chair; Franklin, Vice Chair; Costa, Deccio, Fraser, Parlette and Winsley.

Staff:  Jonathan Seib (786‑7427)

Background:  The term "utilization review" is often used to describe a range of managed care cost containment strategies including monitoring a provider's pattern of treatment, determining the medical necessity of certain types or levels of treatment, and evaluating the efficacy, appropriateness or efficiency of certain treatments for certain health conditions.  These efforts are typically overseen by the "medical director" of the given managed care entity.  Concerns regarding the qualifications and accountability of medical directors have increased as managed care financing arrangements have come to dominate health insurance.

The Patient Bill of Rights, passed by the Legislature in 2000, requires Washington carriers that offer a  health plan to designate a medical director who is licensed to practice in this state.  This requirement, however, does not apply to plans that cover only dental care.

Summary of Bill:  A health carrier that offers dental only coverage must designate a dental director who is licensed as a dentist in Washington.

Appropriation:  None.

Fiscal Note:  Not requested.

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

Testimony For:  None.

Testimony Against:  None.

Testified:  No one.

House Amendment(s):  A carrier's dental director is allowed to be licensed in Washington, or in a state that has been determined by the Dental Quality Assurance Commission to have licensing standards that are substantially equivalent to those in Washington.