[atlas:bill]

AN ACT Relating to protecting a woman's health; amending RCW 48.21.240, 48.44.340, and 48.46.290; adding a new section to chapter 41.05 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 70.47 RCW; adding a new chapter to Title 70 RCW; creating a new section; and repealing RCW 48.21.240, 48.44.340, and 48.46.290.

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

NEW SECTION. Sec. 1. (1) The legislature makes the following findings.

(a) Many women who have undergone abortion complain of nervous disorders and sleep disturbances, regret having made the decision, and obtain prescriptions for psychotropic medicine.

(b) There is significantly greater use of medical and psychiatric services among women who have undergone abortion, and those women are significantly more likely than others to require psychiatric care.

(c) At especially high risk are teenagers, separated or divorced women, and women who have undergone more than one abortion.

(d) Because many women who have undergone abortion rely upon repression as a coping mechanism, those women may long remain in denial before seeking psychiatric care, and repressed feelings may cause psychosomatic illnesses and behavioral or psychological disorders.

(e) Counselors report that unacknowledged postabortion distress is the causative factor in many women who have come to them seeking therapy for problems seemingly unrelated to abortion.

(f) Many women who have undergone abortion suffer from diagnosable posttraumatic stress disorder or postabortion stress.

(g) Posttraumatic stress disorder is a psychological dysfunction rooted in a traumatic experience that overwhelms a person's normal defense mechanisms, resulting in intense fear or feelings of helplessness, captivity, or loss of control. When the stressor leading to posttraumatic stress syndrome is abortion, the condition is frequently termed postabortion syndrome.

(h) Mental, emotional, and psychological disorders, including postabortion syndrome, in adults and in children, are as preventable, controllable, or curable as are physical disorders, and the costs of leaving these disorders untreated or undertreated are enormous, often including decreased job productivity, increased job turnover, increased disability costs, deteriorating school performance, increased use of other health care services, treatment delays leading to more costly treatments, drug and alcohol abuse, suicide, family breakdown and poverty, and institutionalization, whether in hospitals, juvenile detention, jails, or prisons.

(i) It is no longer cost-effective to treat women suffering from abortion-related disorders differently from persons suffering from medical and surgical disorders. The cost to our children, families, businesses, and society as a whole is too high.

(2) The legislature declares that, in the interest of health and welfare, it is the policy of the state to reduce the incidence of postabortion stress syndrome. To reduce the rate of postabortion stress syndrome in Washington, the legislature:

(a) Requires insurance coverage at parity for posttraumatic stress disorder services or postabortion stress health services and requires that this coverage be delivered under the same terms and conditions as medical and surgical coverage;

(b) Authorizes the department of health to contract for provision of postabortion stress syndrome counseling;

(d) Increases funding for providing postabortion stress syndrome counseling, education, outreach, and services.

NEW SECTION. Sec. 2. (1) The postabortion stress syndrome counseling account is created in the state treasury. All receipts from the flat fees imposed and collected under subsection (2) of this section must be deposited into the account. Moneys in the account may be spent only after appropriation. Expenditures from the account may be used only for providing postabortion stress syndrome counseling.

(2) The department of health shall set a flat fee of twenty dollars for each abortion performed under the provisions of chapter 9.02 RCW.

The department shall impose the fee upon the abortion provider, whether that provider is a physician performing the abortion or a facility where the abortion is performed.

The fee is not subject to the retail sales tax. The department shall collect the fee. The provider shall remit the fee to the department for each calendar month, no later than the fifth day of the following calendar month.

If the provider fails to remit the fee to the department as provided, the provider is personally liable to the state for the amount of the fee.

The provider shall certify to the department the number of abortions performed during the calendar month; however, for purposes of this act, the provider shall ensure that the identity of any patient remains confidential.

The department shall deposit fees collected under this section in the postabortion stress syndrome counseling account.

NEW SECTION. Sec. 3. (1) The department of health, to the extent funds are made available, shall:

(a) Contract with counseling specialists or organizations with expertise in postabortion stress syndrome counseling to provide a range of direct treatment services related to postabortion stress syndrome to women who have undergone abortion, fathers of aborted children, and health care personnel who participate or have participated in providing abortions;

(b) Provide an educational program designed to train primary care professionals, such as mental health professionals, about the effects of postabortion stress syndrome;

(c) Provide informational and counseling services to establish and foster peer-support networks throughout the state for families of women who have undergone abortion; and

(d) Provide for the families of women who have undergone abortion, through a referral network of community mental health providers who are skilled in treating postabortion stress syndrome.

(2) For purposes of this act, the department shall not contract with counseling specialists or organizations that provide abortions or abortion referrals or that have board members or officers who provide abortions or abortion referrals.

NEW SECTION. Sec. 4. (1) The department of health shall develop a postabortion stress syndrome counseling media campaign in collaboration with major media organizations and other organizations and corporations interested in playing a positive and constructive role in their communities.

The department shall ensure that the media campaign is designed to reduce the incidence of postabortion stress syndrome, and is directed toward women and to teens, the fathers of aborted children, and health care personnel who participate or have participated in providing abortions.

The department may subcontract all or part of the activities associated with the media campaign to qualified private, nonprofit organizations.

(2) For purposes of this act, the department shall not subcontract with organizations that provide abortions or abortion referrals or that have board members or officers who provide abortions or abortion referrals.

NEW SECTION. Sec. 5. A new section is added to chapter 41.05 RCW to read as follows:

(1) For the purpose of this section, "posttraumatic stress disorder services" or "postabortion stress disorder services" means: (a) Outpatient and inpatient services provided to treat any of the posttraumatic stress disorders or postabortion stress disorders as may be provided by the authority by rule, consistent with the purposes of this act, except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section; and (b) prescription drugs, if the plan contract otherwise includes coverage for prescription drugs.

(2) Each health 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 established or renewed after July 1, 2000, and that provides coverage for hospital or medical care, shall provide coverage for posttraumatic stress disorder services or postabortion stress disorder services. This coverage:

(a) Shall only impose treatment limitations or financial requirements on coverage for posttraumatic stress disorder services or postabortion stress disorder services, if the same limitations or requirements are imposed on coverage for medical and surgical services. This includes but is not limited to copays, cost sharing, annual or lifetime dollar limits, outpatient visit limits, outpatient day limits, and inpatient limits. Wellness and preventive services that are reimbursed at one hundred percent without deductible, coinsurance, or other cost sharing are excluded from this comparison; and

(b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and posttraumatic stress disorder services or postabortion stress disorder services if annual deductibles and maximum out-of-pocket limits are required by the insuring entity. However, no plan is required to initiate the use of such a deductible or limit.

(3) Coverage shall be provided for posttraumatic stress disorder services or postabortion stress disorder services under this section whether services are rendered by any generally recognized medical specialty of practitioners licensed under chapter 18.57 or 18.71 RCW who provide mental health services; psychologists licensed under chapter 18.83 RCW; advanced practice psychiatric nurses as authorized by the nursing care quality assurance commission under chapter 18.79 RCW; social workers, marriage and family therapists, and mental health counselors certified under chapter 18.19 RCW; or community mental health centers licensed under chapter 71.24 RCW.

(4) This section does not prohibit an insuring entity from requiring the use of preauthorization screening prior to authorizing the delivery of posttraumatic stress disorder services or postabortion stress disorder services or the requirement that mental health services must be medically necessary as determined by its medical director or his or her designee.

NEW SECTION. Sec. 6. A new section is added to chapter 48.21 RCW to read as follows:

(1) For the purpose of this section, "posttraumatic stress disorder services" or "postabortion stress disorder services" means: (a) Outpatient and inpatient services provided to treat any of the posttraumatic stress disorders or postabortion stress disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section; and (b) prescription drugs, if the insurance contract otherwise includes coverage for prescription drugs.

(2) All group disability insurance contracts and blanket disability insurance contracts providing health care services to groups with more than fifty persons, issued or renewed after July 1, 2000, and for groups with fifty or fewer persons, issued or renewed after July 1, 2001, that provide coverage for posttraumatic stress disorder services or postabortion stress disorder services. This coverage:

(b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and posttraumatic stress disorder services or postabortion stress disorder services if annual deductibles and maximum out-of-pocket limits are required by the insurer. However, no plan is required to initiate the use of such a deductible or limit.

(4) This section does not prohibit an insurer from requiring the use of preauthorization screening prior to authorizing the delivery of posttraumatic stress disorder services or postabortion stress disorder services or the requirement that posttraumatic stress disorder services or postabortion stress disorder services must be medically necessary as determined by its medical director or his or her designee.

NEW SECTION. Sec. 7. A new section is added to chapter 48.44 RCW to read as follows:

(1) For the purpose of this section, "posttraumatic stress disorder services" or "postabortion stress disorder services" means: (a) Outpatient and inpatient services provided to treat any of the posttraumatic stress disorders or postabortion stress disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section; and (b) prescription drugs, if the contract otherwise includes coverage for prescription drugs.

(2) All health care service contracts for groups with more than fifty persons, issued or renewed after July 1, 2000, and for groups with fifty or fewer persons, issued or renewed after July 1, 2001, that provide coverage for hospital or medical care shall provide coverage for posttraumatic stress disorder services or postabortion stress disorder services. This coverage:

(b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and posttraumatic stress disorder services or postabortion stress disorder services if annual deductibles and maximum out-of-pocket limits are required by the health care service contractor. However, no plan is required to initiate the use of such a deductible or limit.

(4) This section does not prohibit a health care service contractor from requiring the use of preauthorization screening prior to authorizing the delivery of posttraumatic stress disorder services or postabortion stress disorder services or the requirement that posttraumatic stress disorder services or postabortion stress disorder services must be medically necessary as determined by its medical director or his or her designee.

NEW SECTION. Sec. 8. A new section is added to chapter 48.46 RCW to read as follows:

(1) For the purpose of this section, "posttraumatic stress disorder services" or "postabortion stress disorder services" means: (a) Outpatient and inpatient services provided to treat any of the posttraumatic stress disorders or postabortion stress disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section; and (b) prescription drugs, if the plan contract otherwise includes coverage for prescription drugs.

(2) All health benefit plans offered by health maintenance organizations to groups with more than fifty persons, issued or renewed after July 1, 2000, and for groups with fifty or fewer persons, issued or renewed after July 1, 2001, that provide coverage for hospital or medical care shall provide coverage for posttraumatic stress disorder services or postabortion stress disorder services. This coverage:

(b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and posttraumatic stress disorder services or postabortion stress disorder services if annual deductibles and maximum out-of-pocket limits are required by the health maintenance organization. However, no plan is required to initiate the use of such a deductible or limit.

(4) This section does not prohibit a health maintenance organization from requiring the use of preauthorization screening prior to authorizing the delivery of posttraumatic stress disorder services or postabortion stress disorder services or the requirement that posttraumatic stress disorder services or postabortion stress disorder services must be medically necessary as determined by its medical director or his or her designee.

NEW SECTION. Sec. 9. A new section is added to chapter 70.47 RCW to read as follows:

Notwithstanding the provisions of RCW 70.47.060, this section governs the provision of posttraumatic stress disorder services or postabortion stress disorder services to subsidized enrollees in the basic health plan.

(1) For the purpose of this section, "posttraumatic stress disorder services" or "postabortion stress disorder services" means: (a) Outpatient and inpatient services provided to treat any of the posttraumatic stress disorders or postabortion stress disorders covered by the diagnostic categories listed in the most current version of the diagnostic and statistical manual of mental disorders on the effective date of this section, or such subsequent date as may be provided by the Washington state health care authority by rule, consistent with the purposes of this act, except V codes and those codes defining substance abuse disorders, 291.0 through 292.9 and 303.0 through 305.9 as of the effective date of this section; and (b) prescription drugs, if the plan contract otherwise includes coverage for prescription drugs.

(2) After July 1, 2001, the basic health plan shall provide coverage for posttraumatic stress disorder services or postabortion stress disorder services to subsidized children and adults. This coverage:

(b) Shall require one single annual deductible, and one single annual maximum out-of-pocket limit for medical and surgical and posttraumatic stress disorder services or postabortion stress disorder services if annual deductibles and maximum out-of-pocket limits are required by the administrator. However, no plan is required to initiate the use of such a deductible or limit.

(4) This section does not prohibit the administrator from requiring the use of preauthorization screening prior to authorizing the delivery of posttraumatic stress disorder services or postabortion stress disorder services or the requirement that posttraumatic stress disorder services or postabortion stress disorder services must be medically necessary as determined by its medical director or his or her designee.

Sec. 10. RCW 48.21.240 and 1987 c 283 s 3 are each amended to read as follows:

(1) Each group insurer providing disability insurance coverage in this state for hospital or medical care under contracts which are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, for the insured and the insured's covered dependents.

(2) Benefits shall be provided under the optional supplemental coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, whether treatment is rendered by: (a) A physician licensed under chapter 18.71 or 18.57 RCW; (b) a psychologist licensed under chapter 18.83 RCW; (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW; or (d) a state hospital as defined in RCW 72.23.010. The treatment shall be covered at the usual and customary rates for such treatment. The insurer, health care service contractor, or health maintenance organization providing optional coverage under the provisions of this section for mental health services, including posttraumatic stress disorder services or postabortion stress disorder services, may establish separate usual and customary rates for services rendered by physicians licensed under chapter 18.71 or 18.57 RCW, psychologists licensed under chapter 18.83 RCW, and community mental health centers licensed under chapter 71.24 RCW and state hospitals as defined in RCW 72.23.010. However, the treatment may be subject to contract provisions with respect to reasonable deductible amounts or copayments. In order to qualify for coverage under this section, a licensed community mental health agency shall have in effect a plan for quality assurance and peer review, and the treatment shall be supervised by a physician licensed under chapter 18.71 or 18.57 RCW or by a psychologist licensed under chapter 18.83 RCW.

(3) The group disability insurance contract may provide that all the coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, is waived for all covered members if the contract holder so states in advance in writing to the insurer.

(4) This section shall not apply to a group disability insurance contract that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

(5) This section does not apply to groups with more than fifty persons beginning July 1, 2000.

Sec. 11. RCW 48.44.340 and 1987 c 283 s 4 are each amended to read as follows:

(1) Each health care service contractor providing hospital or medical services or benefits in this state under group contracts for health care services under this chapter which are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, for the insured and the insured's covered dependents.

(3) The group contract for health care services may provide that all the coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, is waived for all covered members if the contract holder so states in advance in writing to the health care service contractor.

(4) This section shall not apply to a group health care service contract that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

(5) This section does not apply to groups with more than fifty persons beginning July 1, 2000.

Sec. 12. RCW 48.46.290 and 1987 c 283 s 5 are each amended to read as follows:

(1) Each health maintenance organization providing services or benefits for hospital or medical care coverage in this state under group health maintenance agreements which are issued, delivered, or renewed in this state on or after July 1, 1986, shall offer optional supplemental coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, to the enrolled participant and the enrolled participant's covered dependents.

(2) Benefits shall be provided under the optional supplemental coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, whether treatment is rendered by the health maintenance organization or the health maintenance organization refers the enrolled participant or the enrolled participant's covered dependents for treatment to: (a) A physician licensed under chapter 18.71 or 18.57 RCW; (b) a psychologist licensed under chapter 18.83 RCW; (c) a community mental health agency licensed by the department of social and health services pursuant to chapter 71.24 RCW; or (d) a state hospital as defined in RCW 72.23.010. The treatment shall be covered at the usual and customary rates for such treatment. The insurer, health care service contractor, or health maintenance organization providing optional coverage under the provisions of this section for mental health services, including posttraumatic stress disorder services or postabortion stress disorder services, may establish separate usual and customary rates for services rendered by physicians licensed under chapter 18.71 or 18.57 RCW, psychologists licensed under chapter 18.83 RCW, and community mental health centers licensed under chapter 71.24 RCW and state hospitals as defined in RCW 72.23.010. However, the treatment may be subject to contract provisions with respect to reasonable deductible amounts or copayments. In order to qualify for coverage under this section, a licensed community mental health agency shall have in effect a plan for quality assurance and peer review, and the treatment shall be supervised by a physician licensed under chapter 18.71 or 18.57 RCW or by a psychologist licensed under chapter 18.83 RCW.

(3) The group health maintenance agreement may provide that all the coverage for mental health treatment, including posttraumatic stress disorder services or postabortion stress disorder services, is waived for all covered members if the contract holder so states in advance in writing to the health maintenance organization.

(4) This section shall not apply to a group health maintenance agreement that has been entered into in accordance with a collective bargaining agreement between management and labor representatives prior to March 1, 1987.

(5) This section does not apply to groups with more than fifty persons beginning July 1, 2000.

NEW SECTION. Sec. 13. The following acts or parts of acts are each repealed, effective July 1, 2001:

(1) RCW 48.21.240 (Mental health treatment, optional supplemental coverage--Waiver) and 1999 c . . . s 10 (section 10 of this act), 1987 c 283 s 3, 1986 c 184 s 2, & 1983 c 35 s 1;

(2) RCW 48.44.340 (Mental health treatment, optional supplemental coverage--Waiver) and 1999 c . . . s 11 (section 11 of this act), 1987 c 283 s 4, 1986 c 184 s 3, & 1983 c 35 s 2; and

(3) RCW 48.46.290 (Mental health treatment, optional supplemental coverage--Waiver) and 1999 c . . . s 12 (section 12 of this act), 1987 c 283 s 5, 1986 c 184 s 4, & 1983 c 35 s 3.

NEW SECTION. Sec. 14. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 15. Sections 2 through 4 of this act constitute a new chapter in Title 70 RCW.