5596-S2 AMH APP H5952.1

2SSB 5596  - H COMM AMD
     By Committee on Appropriations

ADOPTED AS AMENDED 03/06/2008

     Strike everything after the enacting clause and insert the following:

"NEW SECTION.  Sec. 1   A new section is added to chapter 48.43 RCW to read as follows:
     (1)(a) Except as provided in (b) of this subsection, a health carrier may not develop and use a payment methodology that would result in a payment to a chiropractor under a physical medicine and rehabilitation payment or billing code in an amount less than a payment to a different provider licensed under Title 18 RCW who is being paid under the same physical medicine and rehabilitation payment or billing code. For payment methodologies that are developed and used on or after January 1, 2009, it is presumed that payment or billing codes that apply only to health care services provided by chiropractors are not in compliance with this requirement unless the carrier shows to the commissioner's satisfaction that the payment or billing codes are used only to achieve the purposes permitted under (b) of this subsection.
     (b) This section does not affect a health carrier's:
     (i) Implementation of a health care quality improvement program to promote cost-effective and clinically efficacious health care services, including but not limited to pay-for-performance payment methodologies and other programs fairly applied to all health care providers licensed under Title 18 RCW that are designed to promote evidence-based and research-based practices;
     (ii) Health care provider contracting to comply with the network adequacy standards of RCW 48.43.515 and the rules adopted by the commissioner establishing network adequacy standards; or
     (iii) Payment differentials that address: (A) The cost of maintaining health care providers' practices including, but not limited to, equipment and overhead costs and medical malpractice insurance premium obligations; (B) differences in applicable provider training requirements; or (C) differences in providers' authorized scope of practice.
     (c) This section does not, and may not be construed to:
     (i) Require the payment of provider billings that do not meet the definition of a clean claim as set forth in rules adopted by the commissioner;
     (ii) Require any health plan to include coverage of any condition; or
     (iii) Expand the scope of practice for any health care provider.
     (2) This section applies only to payment methodologies developed or used on or after January 1, 2009.

Sec. 2   RCW 41.05.017 and 2007 c 502 s 2 are each amended to read as follows:
     Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 43.70.235, 48.43.545, 48.43.550, 70.02.110, 70.02.900, section 1 of this act, and 48.43.083.

NEW SECTION.  Sec. 3   If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2008, in the omnibus appropriations act, this act is null and void."

     Correct the title.

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