BILL REQ. #:  S-1858.1 

Read first time 02/18/09.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to health benefit plans offering coverage for surgical treatment of morbid obesity; adding a new section 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   (1) The legislature finds that:
     (a) Obesity is a growing epidemic among Washington citizens. It is a costly disease that left untreated results in further health complications such as hypertension, cardiopulmonary conditions, sleep apnea, metabolic syndrome, degenerative joint disease, and diabetes;
     (b) A 2007 report from the Washington state department of health indicates that 2.8 percent of Washington adults are morbidly obese;
     (c) A lack of treatment options leaves citizens with morbid obesity very little choice but to pursue other covered health care services that treat secondary health issues caused by excessive weight without solving the underlying problem;
     (d) Surgical solutions to morbid obesity have demonstrated the capacity to produce tremendous weight loss resulting in renewed health and long-term viability for patients that pursue treatment;
     (e) Medical literature indicates that weight loss surgery significantly decreases overall mortality as well as the development of new health-related conditions in morbidly obese patients;
     (f) Evidence-based best practice guidelines for morbid obesity identify gastric reduction surgery as facilitating best patient outcomes where traditional weight loss methods have not worked; and
     (g) Nonexperimental, medically necessary surgical treatments for morbid obesity are a cost-effective solution to this growing health crisis.
     (2) The legislature further finds that the cost of overall health care can be decreased if health plans actively consider nonexperimental, medically necessary obesity surgery for patients where that surgery is the evidence-based standard.
     (3) The legislature further finds that plans should strongly consider waiving contractual benefit exclusions when surgery is the evidence-based standard of treatment and can be reasonably expected to reduce health care costs for that patient by reducing or eliminating health conditions related to the underlying morbid obesity.

NEW SECTION.  Sec. 2   A new section is added to chapter 48.43 RCW to read as follows:
     (1) All health plans issued or renewed after December 31, 2009, must follow the evidence-based standard of care and coverage practices for treatment of morbid obesity. Health carriers shall develop a policy that allows a conditional waiver of contractual benefit exclusions for nonexperimental, medically necessary surgical treatment by a health care provider of morbid obesity, when:
     (a) The condition has persisted for at least five years; and
     (b) Nonsurgical treatment that has been supervised by a physician has been unsuccessful for a least six consecutive months.
     (2) As used in this section, "morbid obesity" is defined as:
     (a) A body mass index of at least thirty-five kilograms per meter squared, with comorbidity or coexisting medical conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or diabetes; or
     (b) A body mass index of at least forty kilograms per meter squared without comorbidity. For purposes of this section, body mass index is equal to weight in kilograms divided by height in meters squared.
     (3) This section does not 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 health carriers to negotiate rates and contract with specific providers for the delivery of nonexperimental, medically necessary surgical treatment by a health care provider of morbid obesity. This section does not apply to medicare supplemental policies or supplemental contracts covering a specified disease or other limited benefits.