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.
