Revised Code of Washington
Chapter 48.46 - Health Maintenance Organizations.
48.46.510 - Phenylketonuria.

RCW 48.46.510
Phenylketonuria.

(1) The legislature finds that:
(a) Phenylketonuria is a rare inherited genetic disorder.
(b) Children with phenylketonuria are unable to metabolize an essential amino acid, phenylalanine, which is found in the proteins of most food.
(c) To remain healthy, children with phenylketonuria must maintain a strict diet and ingest a mineral and vitamin-enriched formula.
(d) Children who do not maintain their diets with the formula acquire severe mental and physical difficulties.
(e) Originally, the formulas were listed as prescription drugs but were reclassified as medical foods to increase their availability.
(2) Subject to requirements and exceptions which may be established by rules adopted by the commissioner, any agreement for health care services delivered or issued for delivery or renewed in this state on or after September 1, 1988, shall provide coverage for the formulas necessary for the treatment of phenylketonuria. Such formulas shall be covered when deemed medically necessary by the medical director or his or her designee of the health maintenance organization and if provided by the health maintenance organization or upon the health maintenance organization's referral. Formulas shall be covered at the usual and customary rates for such formulas, subject to contract provisions with respect to deductible amounts or copayments.

[ 1988 c 173 § 4.]

Structure Revised Code of Washington

Revised Code of Washington

Title 48 - Insurance

Chapter 48.46 - Health Maintenance Organizations.

48.46.010 - Legislative declaration—Purpose.

48.46.012 - Filings with secretary of state—Copy for commissioner.

48.46.020 - Definitions.

48.46.023 - Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.

48.46.027 - Registration, required—Issuance of securities—Penalty.

48.46.030 - Eligibility requirements for certificate of registration—Application requirements, information—Provider compensation.

48.46.033 - Unregistered activities—Acts committed in this state—Sanctions.

48.46.040 - Certificate of registration—Issuance—Grounds for refusal—Name restrictions—Inspection and review of facilities.

48.46.045 - Catastrophic health plans permitted.

48.46.060 - Prepayment agreements—Standards for forms and documents—Grounds for disapproval—Cancellation or failure to renew—Filing of agreement forms.

48.46.062 - Schedule of rates for individual agreements—Loss ratio—Definitions.

48.46.063 - Calculation of premiums—Members of a purchasing pool—Adjusted community rating method—Definitions.

48.46.064 - Calculation of premiums—Adjusted community rate—Definitions.

48.46.066 - Health plan benefits for small employers—Coverage—Exemption from statutory requirements—Premium rates—Requirements for providing coverage for small employers.

48.46.068 - Requirements for plans offered to small employers—Definitions.

48.46.070 - Governing body.

48.46.080 - Annual statement—Filings—Contents—Fee—Penalty for failure to file—Accuracy required.

48.46.090 - Standard of services provided.

48.46.100 - Grievance procedure.

48.46.110 - Name restrictions—Discrimination—Recovery of costs of health care services participant not entitled to.

48.46.120 - Examination of health maintenance organizations—Duties of organizations, powers of commissioner—Independent audit reports.

48.46.130 - Investigation of violations—Hearing—Findings—Penalties—Order requiring compliance, etc.—Suspension or revocation of certificate, effect—Application to courts.

48.46.135 - Fine in addition to or in lieu of suspension, revocation, or refusal.

48.46.140 - Fees.

48.46.170 - Effect of chapter as to other laws—Construction.

48.46.180 - Duty of employer to inform and make available to employees option of enrolling in health maintenance organization.

48.46.190 - Payroll deductions for capitation payments to health maintenance organizations.

48.46.200 - Rules and regulations.

48.46.210 - Compliance with federal funding requirements—Construction.

48.46.220 - Review of administrative action.

48.46.225 - Financial failure—Supervision of commissioner—Priority of distribution of assets.

48.46.235 - Minimum net worth—Requirement to maintain—Determination of amount.

48.46.237 - Minimum net worth—Domestic or foreign health maintenance organization.

48.46.240 - Funded reserve requirements.

48.46.243 - Contract—Participant liability.

48.46.245 - Plan for handling insolvency—Commissioner's review.

48.46.247 - Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.

48.46.250 - Coverage of dependent children—Newborn infants, congenital anomalies—Notification period.

48.46.260 - Individual health maintenance agreement—Return within ten days of delivery—Refunds—Void from beginning.

48.46.270 - Financial interests of health maintenance organization authorities, restricted—Exceptions, regulations.

48.46.272 - Diabetes coverage—Definitions.

48.46.274 - Prescribed, self-administered anticancer medication.

48.46.275 - Mammograms—Insurance coverage.

48.46.277 - Prostate cancer screening.

48.46.280 - Reconstructive breast surgery.

48.46.285 - Mastectomy, lumpectomy.

48.46.291 - Mental health services—Health plans—Definition—Coverage required, when.

48.46.292 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.

48.46.300 - Future dividends or refunds, restricted—Issuance or sale of securities regulated.

48.46.310 - Registration not endorsement.

48.46.320 - Dependent children, termination of coverage, conditions.

48.46.325 - Option to cover child under age twenty-six.

48.46.340 - Return of agreement within ten days.

48.46.350 - Chemical dependency treatment.

48.46.355 - "Chemical dependency" defined.

48.46.360 - Payment of cost of agreement directly to holder during labor dispute—Changes restricted—Notice to employee.

48.46.370 - Coverage not denied for disability.

48.46.375 - Benefits for prenatal diagnosis of congenital disorders—Agreements entered into or renewed on or after January 1, 1990.

48.46.380 - Notice of reason for cancellation, denial, or refusal to renew agreement.

48.46.390 - Providing information on cancellation or refusal—No liability for insurance commissioner or health maintenance organization.

48.46.400 - False or misleading advertising prohibited.

48.46.410 - Misrepresentations to induce termination or retention of agreement prohibited.

48.46.420 - Penalty for violations.

48.46.430 - Enforcement authority of commissioner.

48.46.440 - Continuation option to be offered.

48.46.450 - Conversion agreement to be offered—Exceptions, conditions.

48.46.460 - Conversion agreement—Restrictions and requirements—Rules.

48.46.470 - Endorsement of modifications.

48.46.480 - Continuation of coverage of former family members.

48.46.490 - Coverage for adopted children.

48.46.500 - Cancellation of rider.

48.46.510 - Phenylketonuria.

48.46.520 - Neurodevelopmental therapies—Employer-sponsored group contracts.

48.46.530 - Temporomandibular joint disorders—Insurance coverage.

48.46.535 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

48.46.540 - Nonresident pharmacies.

48.46.565 - Foot care services.

48.46.570 - Denturist services.

48.46.575 - Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.

48.46.580 - When injury caused by intoxication or use of narcotics.

48.46.600 - Disclosure of certain material transactions—Report—Information is confidential.

48.46.605 - Material acquisitions or dispositions.

48.46.610 - Asset acquisitions—Asset dispositions.

48.46.615 - Report of a material acquisition or disposition of assets—Information required.

48.46.620 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

48.46.625 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

48.46.900 - Liberal construction.

48.46.920 - Short title.

48.46.930 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.