SB 6651 - DIGEST

Requires the department of social and health services to establish an evidence-based medical necessity definition and decision-making process for its medical assistance programs.

Finds that: The robust development and availability of new drugs, treatments, and therapies requires greater efforts to assure that medical assistance clients will not be harmed or injured by inappropriate service utilization; the growing limitations on available resources require funds be spent in a cost-efficient and effective manner to improve the health of clients; the department's current definition of medical necessity for determining services under chapter 74.09 RCW is outdated and inadequate; and certain orders in Washington state superior court cases unduly restrict the department from adopting necessary rule modifications, which results in inefficiencies and possible harm to clients.

Declares an intent that the department adopt a new definition and decision-making process for the term "medical necessity" for use in programs authorized under this chapter that, to the extent possible, improves health status and avoids harm to clients.