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AN ACT Rel at i ng t o servi ces provi ded by pharmaci st s; amendi ng RCW1

48. 43. 045; and addi ng a new sect i on t o chapter 48. 43 RCW.2

BE I T ENACTED BY THE LEGI SLATURE OF THE STATE OF WASHI NGTON:3

NEW SECTI ON. Sec. 1. A new sect i on i s added t o chapt er 48. 434

RCW t o r ead as f ol l ows:5For heal t h pl ans i ssued or r enewed on or af t er J anuary 1, 2016,6

benef i t s shal l not be deni ed f or any heal t h car e servi ce per f or med by7

a phar maci st l i censed under chapt er 18. 64 RCW i f ( 1) t he ser vi ce8

per f or med was wi t hi n t he l awf ul scope of such per son' s l i cense; ( 2)9

t he pl an woul d have pr ovi ded benef i t s i f t he ser vi ce had been10

per f ormed by a physi ci an l i censed under chapter 18. 71 or 18. 57 RCW,11

an advanced r egi st er ed nur se pr act i t i oner l i censed under chapt er12

18. 79 RCW, or a physi ci an' s assi st ant l i censed under chapt er 18. 71A13

or 18. 57A RCW; and ( 3) t he pharmaci st i s i ncl uded i n t he pl an' s14

net wor k of par t i ci pat i ng pr ovi der s. Thi s sect i on does not super sede15

t he r equi r ement s of RCW 48. 43. 045.16

Sec. 2. RCW 48. 43. 045 and 2007 c 253 s 12 ar e each amended t o17

r ead as f ol l ows:18

( 1) Ever y heal t h pl an del i ver ed, i ssued f or del i ver y, or r enewed19

by a heal t h car r i er on and af t er J anuar y 1, 1996, shal l :20

S- 0930. 1

SENATE BILL 5557

State of Washington 64th Legislature 2015 Regular Session

By Senat or s Par l et t e, Conway, Ri ver s, Dammei er , Becker , Frockt ,Schoesl er , Kei ser , J ayapal , War ni ck, and Honeyf or d

Read f i r st t i me 01/ 23/ 15. Ref err ed t o Commi t t ee on Heal t h Care.

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( a) Per mi t ever y cat egor y of heal t h car e pr ovi der t o pr ovi de1

heal t h ser vi ces or car e ( ( f or condi t i ons) ) i ncl uded i n t he ( ( basi c2

heal t h pl an ser vi ces) ) essent i al heal t h benef i t s benchmar k pl an3

est abl i shed by t he commi ssi oner consi st ent wi t h RCW 48. 43. 715, t o t he4

ext ent t hat :5

( i ) The pr ovi si on of such heal t h ser vi ces or car e i s wi t hi n t he6

heal t h car e pr ovi der s' per mi t t ed scope of pr act i ce; ( ( and) )7( i i ) The pr ovi der s agr ee t o abi de by st andar ds r el at ed t o:8

( A) Pr ovi si on, ut i l i zat i on r evi ew, and cost cont ai nment of heal t h9

ser vi ces;10

( B) Management and admi ni st r at i ve pr ocedur es; and11

( C) Pr ovi si on of cost- ef f ect i ve and cl i ni cal l y ef f i caci ous heal t h12

ser vi ces; and13

( i i i ) For t he pur poses of t hi s subsect i on, a heal t h pl an14

del i ver ed, i ssued f or del i ver y, or r enewed f or a gr oup ot her t han a15

smal l gr oup must use a def i ni t i on of essent i al benef i t s aut hor i zed by16

t he f eder al secret ary of t he depar t ment of heal t h and human servi ces17

t o meet t he r equi r ement s of P. L. 111- 148 of 2010, as amended,18

i ncl udi ng any avai l abl e benchmark opt i on, suppl ement ed as needed t o19

ensur e cover age of al l t en st at ut or y cat egor i es.20

( b) Annual l y repor t t he names and addr esses of al l of f i cer s,21

di r ect or s, or t r ust ees of t he heal t h car r i er dur i ng t he pr ecedi ng22

year , and t he amount of wages, expense rei mbur sement s, or ot her23

payment s t o such i ndi vi dual s, unl ess subst ant i al l y si mi l ar24i nf or mat i on i s f i l ed wi t h t he commi ssi oner or t he nat i onal25

associ at i on of i nsurance commi ssi oner s. Thi s r equi r ement does not26

appl y t o a f or ei gn or al i en i nsur er r egul at ed under chapt er 48. 20 or27

48. 21 RCW t hat f i l es a suppl ement al compensat i on exhi bi t i n i t s28

annual st at ement as r equi r ed by l aw.29

( 2) The r equi r ement s of subsect i on ( 1) ( a) of t hi s sect i on do not30

appl y t o a l i censed heal t h car e pr of essi on r egul at ed under Ti t l e 1831

RCW when t he l i censi ng st at ut e f or t he pr of essi on st at es t hat such32

r equi r ement s do not appl y.33

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