BILL REQ. #:  S-0244.1 

Read first time 01/12/2005.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to periodontal insurance coverage; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   (1) The legislature finds that:
     (a) Periodontal disease is a serious public health problem that poses a potential threat to the health of millions of Americans, three-quarters of whom will experience at least mild periodontal disease during their lifetime;
     (b) Studies have indicated that people with periodontal disease may be at higher risk of developing heart disease, stroke, uncontrolled diabetes, and respiratory disease. Women with periodontal disease may be at a higher risk of delivering premature babies;
     (c) Periodontal disease, a bacterial infection, is preventable;
     (d) A lack of access to, and coverage for, preventative dental health and periodontal services threatens the health status of residents of the state; and
     (e) Educating the public and the health care community about the extent to which the lack of insurance coverage for periodontal services is a barrier to accessing appropriate periodontal care is a benefit to all the residents of the state.
     (2) The office of the insurance commissioner must conduct a study to:
     (a) Determine the level of insurance coverage provided for a range of services known to be effective in preventing and treating periodontal disease; and
     (b) Assess whether the level of coverage is adequate to meet the public need and make appropriate recommendations to the legislature about strategies for meeting those needs, and the costs and benefits of implementing these strategies.
     (3) In conducting the study required under subsection (2) of this section, the office of the insurance commissioner must:
     (a) Consult with public and private purchasers of health services. This includes health carriers, health care providers, including but not limited to dentists and periodontal specialists, and consumers of dental health services, to facilitate in the design of the study; and
     (b) Consider the following questions in assessing the level of insurance coverage for services known to be effective in preventing and treating periodontal disease:
     (i) To what extent is coverage available for the range of services that are generally recognized as necessary to meet basic oral health needs?;
     (ii) Does the available coverage encourage services that promote prevention?;
     (iii) Do different types of insurance plans, whether indemnity, preferred provider organization, point of service, managed care, or other types offer different levels of coverage and cost sharing?;
     (iv) If coverage for certain services is not available, to what extent has a lack of coverage resulted in people not receiving needed services?;
     (v) If coverage for certain services is not available, has the lack of coverage resulted in unreasonable financial hardship?; and
     (vi) To what extent would broader coverage increase the cost of health care services and premiums for coverage?
     (4) The office of the insurance commissioner must submit a report of its findings to the legislature by December 31, 2005, and the report must include recommendations required under subsection (2)(b) of this section.
     (5) The office of the insurance commissioner may accept grants, services, and property from the federal government, foundations, organizations, medical schools, and other entities as are available for carrying out the purposes of this act.