AN ACT Relating to general anesthesia services; adding a new section to chapter 41.05 RCW; 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 41.05 RCW to read as follows:

(1) Each employee benefit plan offered to public employees and their covered dependents that provides coverage for hospital, medical, or ambulatory surgery center services must cover hospital and general anesthesia services in conjunction with dental procedures in a hospital or ambulatory surgical center if such hospitalization is medically necessary because the covered person:

(a) Is under the age of seven with a dental condition and the required procedure cannot be safely and effectively performed in a dental office;

(b) Is physically or developmentally disabled and cannot be safely and effectively treated in a dental office; or

(c) Has at least one medical condition that would create an undue medical risk if treatment is not performed in a hospital or ambulatory surgery center as determined by the patient's physician; such treatment must be approved by the patient's physician.

(2) Each employee benefit plan offered to public employees and their covered dependents that provides coverage for dental services must cover general anesthesia services in conjunction with covered dental procedures if such services are medically necessary because the covered person is:

(a) Under the age of seven and the required procedure can be safely and effectively performed in a dental office; or

(b) Physically or developmentally disabled and can be safely and effectively treated in a dental office.

(3) This section does not:

(a) Prevent the application of standard cost-sharing requirements applicable to other covered benefits;

(b) Limit the authority in negotiating rates and contracts with specific providers;

(c) Apply to medicare supplement policies or supplemental contracts covering a specified disease or other limited benefits; or

(d) Prevent the requirement that services be provided in a participating health care facility.

(4) Prior authorization may be required in a manner similar for hospitalization of other covered conditions.

(5) For the purpose of this section, "general anesthesia" means a state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command.

(6) This section applies to employee benefit plans issued or renewed on or after the effective date of this section.

(7) An employee benefit plan or health carrier that covers hospital or general anesthesia services under this section is not responsible for, or liable with respect to, the services of a dentist when those services are not covered by the carrier.

NEW SECTION. Sec. 2. A new section is added to chapter 48.43 RCW to read as follows:

(1) Each health carrier that provides group coverage for hospital, medical, or ambulatory surgery center services must cover hospital and general anesthesia services in conjunction with dental procedures in a hospital or ambulatory surgical center if such hospitalization is medically necessary because the covered person:

(a) Is under the age of seven with a dental condition and the required procedure cannot be safely and effectively performed in a dental office;

(b) Is physically or developmentally disabled and cannot be safely and effectively treated in a dental office; or

(2) Each health carrier that provides group coverage for dental benefits must cover general anesthesia services in conjunction with covered dental procedures if such services are medically necessary because the covered person is:

(a) Under the age of seven and the required procedure can be safely and effectively performed in the dental office; or

(b) Physically or developmentally disabled and can safely and effectively be treated in the dental office.

(3) This section does not:

(a) Prevent the application of standard cost-sharing requirements applicable to other covered benefits;

(b) Limit the health carrier in negotiating rates and contracts with specific providers;

(c) Apply to medicare supplement policies or supplemental contracts covering a specified disease or other limited benefits; or

(d) Prevent the requirement that services be provided in a participating health care facility.

(4) Prior authorization may be required in a manner similar for hospitalization of other covered conditions.

(6) This section applies to health benefit plans and dental plans authorized under RCW 48.44.035 issued or renewed on or after the effective date of this section.

(7) Each health carrier that covers hospital or general anesthesia services under this section is not responsible for, or liable with respect to, the services of a dentist when those services are not covered by the carrier.