5597-S2 AMH HCW H3090.1

2SSB 5597  - H COMM AMD
     By Committee on Health Care & Wellness

NOT ADOPTED 04/06/2007

     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) Health carriers may not directly or indirectly, through contract or otherwise, refuse to reimburse a chiropractor, who has signed a participating provider agreement, for the provision of health care services if:
     (a) The health care service is:
     (i) Medically necessary;
     (ii) Within the scope of practice of the chiropractor;
     (iii) Provided by the chiropractor or the chiropractor's employees who work in the same location as the chiropractor and either are licensed under chapter 18.25 RCW or are employees specified in RCW 18.25.190 (2) or (3) to whom the chiropractor has delegated the work pursuant to rules adopted by the Washington state chiropractic quality assurance commission. Such employees must meet the health carrier's reasonable qualifications for all such providers in the relevant class, including but not limited to standards for education, background checks, and licensure, as applicable; and
     (iv) Covered chiropractic health care, as defined in RCW 48.43.515, for the health plan under which the enrollee received the services; and
     (b) The chiropractor complies with the terms and conditions of the participating provider agreement, including any requirements for cost containment or participation in an evidence-based quality assurance program.
     (2) When offering a plan network provider contract to a chiropractic practice, whether the practice consists of two or more chiropractors as partners, members, or shareholders, health carriers must offer all chiropractors in the practice the opportunity to be participating providers, subject to the chiropractor's compliance with RCW 48.43.045(1)(b). This subsection does not prohibit a participating provider agreement from allowing either party to terminate the agreement without cause under the terms of the agreement.
     (3) This section does not relieve a chiropractor from responsibility or liability imposed by law for delegated services performed by the chiropractor's employee.
     (4) Any term or condition of any participating provider agreement between a chiropractor and a health carrier that attempts to waive this section is invalid.
     (5) This section applies only to participating provider agreements that are executed or renewed on or after January 1, 2008.

NEW SECTION.  Sec. 2   This act does not affect any existing right acquired or liability or obligation incurred prior to the effective date of this act.

NEW SECTION.  Sec. 3   If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected."

     Correct the title.

EFFECT:  Makes various technical and reorganizing changes, including deleting explicit provisions that would not have allowed contracts to prohibit delegation of duties or to require compliance with health care delivery standards conflicting with those adopted by the Washington State Chiropractic Quality Assurance Commission.
     Adds the following conditions to the requirement that health carriers must reimburse participating chiropractors for provided health care services:
     (1) The services must be medically necessary and within the chiropractor's scope of practice;
     (2) The work must be performed by the chiropractor or by the chiropractor's employees who work in the same location and are either licensed chiropractors or are legally delegated the work as chiropractic students or postgraduate trainees, as long as the employees meet standards required by the health carrier for the class of providers;
     (3) The services must be a covered benefit; and
     (4) The chiropractor must comply with cost containment and quality assurance requirements of the provider agreement.
     Adds that health carriers offering network provider contracts to chiropractic practices of two or more chiropractors must offer the opportunity for all chiropractors to be participating providers, if the chiropractors comply with standards listed in statute, including cost containment, administrative procedures, and efficacious care.

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