BILL REQ. #: S-1231.1
| State of Washington | 61st Legislature | 2009 Regular Session |
Read first time 02/03/09. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to harmonizing health benefit plans to provide coverage for elemental formulas; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new section to chapter 48.125 RCW; adding a new section to chapter 70.47 RCW; and adding a new section to chapter 74.09 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 plan offered to public employees and their covered
dependents under this chapter that is not subject to the provisions of
Title 48 RCW and is issued or renewed after December 31, 2009, shall
provide coverage for amino acid-based elemental formulas for infants
and children when medically necessary, regardless of the delivery
method. The diagnosis of a disease or condition and administration of
the formulas must be ordered by a health care professional licensed
under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of the health care authority to negotiate rates and contract
with specific providers for the delivery of covered services. This
section does not apply to medicare supplemental policies or
supplemental contracts covering a specified disease or other limited
benefits.
NEW SECTION. Sec. 2 A new section is added to chapter 48.20 RCW
to read as follows:
(1) Each disability insurance policy issued or renewed after
December 31, 2009, that provides coverage for hospital or medical
expenses shall provide coverage for amino acid-based elemental formulas
for infants and children when medically necessary, regardless of the
delivery method. The diagnosis of a disease or condition and
administration of the formulas must be ordered by a health care
professional licensed under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of an insurer to negotiate rates and contract with specific
providers for the delivery of covered services. This section does not
apply to medicare supplemental policies or supplemental contracts
covering a specified disease or other limited benefits.
NEW SECTION. Sec. 3 A new section is added to chapter 48.21 RCW
to read as follows:
(1) Each group disability insurance policy issued or renewed after
December 31, 2009, that provides coverage for hospital or medical
expenses shall provide coverage for amino acid-based elemental formulas
for infants and children when medically necessary, regardless of the
delivery method. The diagnosis of a disease or condition and
administration of the formulas must be ordered by a health care
professional licensed under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of an insurer to negotiate rates and contract with specific
providers for the delivery of covered services. This section does not
apply to medicare supplemental policies or supplemental contracts
covering a specified disease or other limited benefits.
NEW SECTION. Sec. 4 A new section is added to chapter 48.44 RCW
to read as follows:
(1) Each health care service contract issued or renewed after
December 31, 2009, that provides coverage for hospital or medical
expenses shall provide coverage for amino acid-based elemental formulas
for infants and children when medically necessary, regardless of the
delivery method. The diagnosis of a disease or condition and
administration of the formulas must be ordered by a health care
professional licensed under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of a contractor to negotiate rates and contract with specific
providers for the delivery of covered services. This section does not
apply to medicare supplemental policies or supplemental contracts
covering a specified disease or other limited benefits.
NEW SECTION. Sec. 5 A new section is added to chapter 48.46 RCW
to read as follows:
(1) Each health maintenance agreement issued or renewed after
December 31, 2009, that provides coverage for hospital or medical
expenses shall provide coverage for amino acid-based elemental formulas
for infants and children when medically necessary, regardless of the
delivery method. The diagnosis of a disease or condition and
administration of the formulas must be ordered by a health care
professional licensed under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of a health maintenance organization to negotiate rates and
contract with specific providers for the delivery of covered services.
This section does not apply to medicare supplemental policies or
supplemental contracts covering a specified disease or other limited
benefits.
NEW SECTION. Sec. 6 A new section is added to chapter 48.125 RCW
to read as follows:
(1) Each self-funded multiple employer welfare arrangement
established, operated, providing benefits, or maintained in this state
after December 31, 2009, that provides coverage for hospital or medical
expenses shall provide coverage for amino acid-based elemental formulas
for infants and children when medically necessary, regardless of the
delivery method. The diagnosis of a disease or condition and
administration of the formulas must be ordered by a health care
professional licensed under chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of a self-funded multiple employer welfare arrangement to
negotiate rates and contract with specific providers for the delivery
of covered services. This section does not apply to medicare
supplemental policies or supplemental contracts covering a specified
disease or other limited benefits.
NEW SECTION. Sec. 7 A new section is added to chapter 70.47 RCW
to read as follows:
(1) Any schedule of benefits established or renewed by the
Washington basic health plan after December 31, 2007, shall provide
coverage for amino acid-based elemental formulas for infants and
children when medically necessary, regardless of the delivery method.
The diagnosis of a disease or condition and administration of the
formulas must be ordered by a health care professional licensed under
chapter 18.57 or 18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of the health care authority to negotiate rates and contract
with specific providers for the delivery of covered services. This
section does not apply to medicare supplemental policies or
supplemental contracts covering a specified disease or other limited
benefits.
NEW SECTION. Sec. 8 A new section is added to chapter 74.09 RCW
to read as follows:
(1) The department shall provide coverage under this chapter for
amino acid-based elemental formulas for infants and children when
medically necessary, regardless of the delivery method. The diagnosis
of a disease or condition and administration of the formulas must be
ordered by a health care professional licensed under chapter 18.57 or
18.71 RCW.
(2) This section shall not be construed to prevent the application
of standard policy provisions applicable to other benefits, such as
deductible or copayment provisions. This section does not limit the
authority of the department to negotiate rates and contract with
specific providers for the delivery of covered services. This section
does not apply to medicare supplemental policies or supplemental
contracts covering a specified disease or other limited benefits.