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 that provides coverage for hospital,
medical, or ambulatory surgery center services must cover general anesthesia
services and related facility charges in conjunction with any dental procedure
performed in a hospital or ambulatory surgical center if such anesthesia
services and related facility charges are medically necessary because the
covered person:
(a) Is under the age of
seven, or physically or developmentally disabled, with a dental condition that
cannot be safely and effectively treated in a dental office; or
(b) Has a medical
condition that the person's physician determines would place the person at
undue risk if the dental procedure were performed in a dental office. The
procedure must be approved by the person's physician.
(2) Each employee
benefit plan offered to public employees that provides coverage for dental
services must cover general anesthesia services in conjunction with any covered
dental procedure performed in a dental office if the general anesthesia
services are medically necessary because the covered person is under the age of
seven or physically or developmentally disabled.
(3) This section does
not prohibit an employee benefit plan from:
(a) Applying
cost-sharing requirements, maximum annual benefit limitations, and prior
authorization requirements to the services required under this section; or
(b) Covering only those
services performed by a health care provider, or in a health care facility,
that is part of its provider network; nor does it limit the authority in
negotiating rates and contracts with specific providers.
(4) This section does
not apply to medicare supplement policies, or supplemental contracts covering a
specified disease or other limited benefits.
(5) For the purpose of
this section, "general anesthesia services" means services to induce
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 January 1,
2002.
NEW SECTION. Sec.
2. A new section is added
to chapter 48.43 RCW to read as follows:
(1) Each group health
benefit plan that provides coverage for hospital, medical, or ambulatory
surgery center services must cover general anesthesia services and related
facility charges in conjunction with any dental procedure performed in a
hospital or ambulatory surgical center if such anesthesia services and related
facility charges are medically necessary because the covered person:
(a) Is under the age of
seven, or physically or developmentally disabled, with a dental condition that
cannot be safely and effectively treated in a dental office; or
(b) Has a medical
condition that the person's physician determines would place the person at
undue risk if the dental procedure were performed in a dental office. The
procedure must be approved by the person's physician.
(2) Each group health
benefit plan or group dental plan that provides coverage for dental services
must cover medically necessary general anesthesia services in conjunction with
any covered dental procedure performed in a dental office if the general
anesthesia services are medically necessary because the covered person is under
the age of seven or physically or developmentally disabled.
(3) This section does
not prohibit a group health benefit plan or group dental plan from:
(a) Applying cost-sharing
requirements, maximum annual benefit limitations, and prior authorization
requirements to the services required under this section; or
(b) Covering only those
services performed by a health care provider, or in a health care facility,
that is part of its provider network; nor does it limit the health carrier in
negotiating rates and contracts with specific providers.
(4) This section does
not apply to medicare supplement policies, or supplemental contracts covering a
specified disease or other limited benefits.
(5) For the purpose of
this section, "general anesthesia services" means services to induce
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 group health benefit plans and group dental plans issued or
renewed on or after January 1, 2002.
