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Washington State
BILL REQ. #:H-4818.1/04
ATTY/TYPIST: RJS:ads
BRIEF DESCRIPTION: Requiring health care coverage for prosthetic devices.

AN ACT Relating to health care coverage for prosthetic devices; 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; and providing an effective date.

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) All state-purchased health care purchased or renewed after the effective date of this act shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 D.S.C. Sees. 1395k, 13951, and 1395m and 42 C.F.R. 414.202, 414.210, 414.228, and 410.100, as applicable to this section.

(2) For the purposes of this section ”prosthetic device” means an artificial device to replace, in whole or in part, an arm or leg.

(3) Prior authorization may be required for prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(4) Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician.

(5) Repairs and replacements of prosthetic devices are also covered, subject to copayments and deductib1es, unless necessitated by misuse or loss.

(6) The benefits mandated pursuant to this section may require that prosthetic devices be provided by a vendor and prosthetic services be rendered by a provider who contracts with or is designated by the state agency purchasing health care services. To the extent that in-network and out-of-network services are provided, the coverage for the prosthetic device shall be offered no less extensively.

NEW SECTION.Sec. 2. A new section is added to chapter 48.20 RCW to read as follows:

(1) All disability insurance contracts providing health care services, delivered or issued for delivery in this state or issued or renewed after the effective date of this act, shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U. S. C. Secs. 1395k, 13951, and 1395m and 42 C. F. R. 414.202, 414.210, 414.228, and 410.100, as applicable to this section.

(2) For the purposes of this section "prosthetic device" means an artificial device to replace, in whole or in part, an arm or leg.

(3) Prior authorization may be required for prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(4) Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician.

(5) Repairs and replacements of prosthetic devices are also covered, subject to copayments and deductib1es, unless necessitated by misuse or loss.

(6) The benefits mandated pursuant to this section may require that prosthetic devices be provided by a vendor and prosthetic services be rendered by a provider who contracts with or is designated by the insurer. To the extent that in-network and out-of-network services are provided, the coverage for the prosthetic device shall be offered no less extensively.

NEW SECTION. Sec. 3. A new section is added to chapter 48.21 RCW to read as follows:

(1) All group disability insurance contracts and blanket disability insurance contracts providing health care services, issued or renewed after the effective date of this act, shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. Secs. 1395k, 13951, and 1395m and 42 C.F.R. 414.202, 414.210, 414.228, and 410.100, as applicable to this section.

(2) For the purposes of this section "prosthetic device" means an artificial device to replace, in whole or in part, an arm or leg.

(3) Prior authorization may be required for prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(4) Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician.

(5) Repairs and replacements of prosthetic devices are also covered, subject to copayments and deductibles, unless necessitated by misuse or loss.

(6) The benefits mandated pursuant to this section may require that prosthetic devices be provided by a vendor and prosthetic services be rendered by a provider who contracts with or is designated by the insurer. To the extent that in-network and out-of-network services are provided, the coverage for the prosthetic device shall be offered no less extensively.

NEW SECTION. Sec. 4. A new section is added to chapter 48.44 RCW to read as follows:

(1) All health benefit plans offered by health care service contractors, issued or renewed after the effective date of this act, shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. Secs. 1395k, 13951, and 1395m and 42 C.F.R. 414.202, 414.210, 414.228, and 410.100, as applicable to this section.

(2) For the purposes of this section "prosthetic device" means an artificial device to replace, in whole or in part, an arm or leg.

(3) Prior authorization may be required for prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(4) Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician.

(5) Repairs and replacements of prosthetic devices are also covered, subject to copayments and deductibles, unless necessitated by misuse or loss.

(6) The benefits mandated pursuant to this section may require that prosthetic devices be provided by a vendor and prosthetic services be rendered by a provider who contracts with or is designated by the health care services contractor. To the extent that in-network and out-of-network services are provided, the coverage for the prosthetic device shall be offered no less extensively.

NEW SECTION. Sec. 5. A new section is added to chapter 48.46 RCW to read as follows:

(1) All health benefit plans offered by health maintenance organizations, issued or renewed after the effective date of this act, shall provide coverage for benefits for prosthetic devices that equal those benefits provided for under federal laws for health insurance for the aged and disabled pursuant to 42 U.S.C. Sees. 1395k, 139511 and 1395m and 42 C.F.R. 414.202, 414.210, 414.228, and 410.100, as applicable to this section.

(2) For the purposes of this section "prosthetic device" means an artificial device to replace, in whole or in part, an arm or leg.

(3) Prior authorization may be required for prosthetic devices in the same manner that prior authorization is required for any other covered benefit.

(4) Covered benefits are limited to the most appropriate model that adequately meets the medical needs of the patient as determined by the insured's treating physician.

(5) Repairs and replacements of prosthetic devices are also covered, subject to c6payments and deductibles, unless necessitated by misuse or loss.

(6) The benefits mandated pursuant to this section may require that prosthetic devices be provided by a vendor and prosthetic services be rendered by a provider who contracts with or is designated by the health maintenance organization. To the extent that in-network and out-of-network services are provided, the coverage for the prosthetic device shall be offered no less extensively.

NEW SECTION. Sec. 6.This act takes effect January 1, 2006.

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