Passed by the Senate March 12, 2008 YEAS 46 NAYS 3 ________________________________________ President of the Senate Passed by the House March 12, 2008 YEAS 81 NAYS 16 ________________________________________ Speaker of the House of Representatives		CERTIFICATE I, Thomas Hoemann, Secretary of the Senate of the State of Washington, do hereby certify that the attached is SECOND SUBSTITUTE SENATE BILL 5596 as passed by the Senate and the House of Representatives on the dates hereon set forth. ________________________________________ Secretary
Approved ________________________________________ Governor of the State of Washington		FILED Secretary of State State of Washington

AN ACT Relating to fair payment for chiropractic services; amending RCW 41.05.017; adding new sections to chapter 48.43 RCW; and providing an expiration date.

NEW SECTION.  Sec. 1   A new section is added to chapter 48.43 RCW to read as follows:
     (1)(a) A health carrier may not pay a chiropractor less for a service or procedure identified under a particular physical medicine and rehabilitation code or evaluation and management code, as listed in a nationally recognized services and procedures code book such as the American medical association current procedural terminology code book, than it pays any other type of provider licensed under Title 18 RCW for a service or procedure under the same code, except as provided in (b) of this subsection. A carrier may not circumvent this requirement by creating a chiropractor-specific code not listed in the nationally recognized code book otherwise used by the carrier for provider payment.
     (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;
     (iii) Authority to pay in-network providers differently than out-of-network providers; and
     (iv) Authority to pay a chiropractor less than another provider for procedures or services under the same code based upon geographic differences in the cost of maintaining a 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 payments made 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   A new section is added to chapter 48.43 RCW to read as follows:
     (1) On or after January 1, 2010, the commissioner shall contract for an evaluation of the impact of section 1 of this act on the utilization and cost of health care services associated with physical medicine and rehabilitation payment or billing codes and evaluation and management payment or billing codes, and on the total cost of episodes of care for treatment associated with the use of these payment or billing codes.
     (2) The commissioner shall require carriers to provide to the contractor such data as the contractor determines is necessary to complete the evaluation under subsection (1) of this section. Data may include, but need not be limited to, the following:
     (a) Data on the utilization of physical medicine and rehabilitation services and evaluation and management services associated with payment or billing codes for those services;
     (b) Data related to changes in the distribution or mix of health care providers providing services under physical medicine and rehabilitation payment or billing codes and evaluation and management payment or billing codes;
     (c) Data related to trends in carrier expenditures for services associated with physical medicine and rehabilitation payment or billing codes and evaluation and management payment or billing codes; and
     (d) Data related to trends in carrier expenditures for the total cost of health plan enrollee care for treatment of the presenting health problems associated with the use of physical medicine and rehabilitation payment or billing codes and evaluation and management payment or billing codes.
     (3) Data, information, and documents provided by the carrier pursuant to this section are exempt from public inspection and copying under chapter 42.56 RCW.
     (4) The commissioner shall submit the evaluation required in subsection (1) of this section to the appropriate committees of the senate and house of representatives by January 1, 2012.