S-1866

AN ACT Relating to health insurance benefits for eating disorders; adding new sections to chapter 48.43 RCW; and creating a new section.

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

NEW SECTION. Sec. 1. The legislature finds that the health and well-being of children and young adults is of critical importance to the public welfare. The legislature further finds that eating disorders are more prevalent among adolescents and young adults, and that the incidence of the disease has increased in recent decades. The legislature further finds that persons with eating disorders often fail to receive the comprehensive care that studies have shown to be most useful in treating these illnesses. This lack of adequate coverage has a detrimental effect on the men and women most commonly afflicted with these illnesses, and can result in long-term emotional and physical damage, including death from starvation and suicide.

It is the intent of the legislature to improve the general welfare of children, adolescents, and adults by ensuring that health carriers provide sufficient health care coverage to effectively treat eating disorders.

NEW SECTION. Sec. 2. The definitions in this section apply throughout sections 3 through 5 of this act, unless the context clearly requires otherwise.

(1) "Eating disorder" means the eating 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 commissioner by rule, consistent with the purposes of chapter . . ., Laws of 1999 (this act).

(2) "Health carrier" or "carrier" includes disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, health maintenance organizations regulated under chapter 48.46 RCW, plans operating under the health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapter 48.41 RCW, and insuring entities regulated under this chapter.

NEW SECTION. Sec. 3. (1) Every health carrier that provides coverage for hospital or medical care shall provide coverage for treatment for eating disorders. Where appropriate, treatment may involve a comprehensive approach, which may include, but is not limited to, a primary care physician, an internist, a nutritionist, a dietician, a psychotherapist, a psychopharmacologist, and family counseling.

(2) The schedule of services for the treatment of eating disorders required by sections 2 through 5 of this act must be at least as favorable as the coverage made available for services and benefits for other major illnesses and must include the durational limits, amount limits, deductibles, coinsurance factors, visits, or day limits that are at least as favorable as those for services and benefits for other major illnesses. However, no health carrier is required to initiate the use of such a deductible or limit.

(3) This section does not prohibit an insuring entity from requiring the use of preauthorization screening prior to authorizing the treatment of eating disorders or the requirement that the treatment of eating disorders be medically necessary as determined by its medical director or his or her designee.

NEW SECTION. Sec. 4. Every health carrier must provide notice to policyholders regarding the coverage required under sections 2 through 5 of this act. The notice must be in writing and must be transmitted to the policyholder when the yearly summary of benefits is mailed to the policyholder, or July 31, 2000, whichever is earlier.

NEW SECTION. Sec. 5. All health benefit plans issued or renewed by any health carrier after December 31, 1999, are required to be in accordance with sections 2 through 4 of this act.

NEW SECTION. Sec. 6. Sections 2 through 5 of this act are each added to chapter 48.43 RCW.