BILL REQ. #:  H-3127.1 

Prefiled 01/06/14. Read first time 01/13/14.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to the treatment of eosinophilic gastrointestinal associated disorders; and adding a new section to chapter 48.43 RCW.

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

NEW SECTION.  Sec. 1   A new section is added to chapter 48.43 RCW to read as follows:
     (1) Each health benefit plan issued or renewed after December 31, 2015, must offer benefits or coverage for medically necessary elemental formula, regardless of delivery method, when a licensed physician or other health care provider with prescriptive authority:
     (a) Diagnoses a patient with an eosinophilic gastrointestinal associated disorder; and
     (b) Orders and supervises the use of the elemental formula.
     (2) The cost-sharing for medically necessary elemental formula must be included in the expenses that count toward the enrollee's annual out-of-pocket maximum, unless prohibited by the federal patient protection and affordable care act, P.L. 111-148, as amended by the federal health care and education reconciliation act of 2010, P.L. 111-152, or federal regulations or guidance issued under the affordable care act.
     (3) Nothing in this section prohibits a health benefit plan from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for medically necessary elemental formula.