BILL REQ. #:  S-0520.1 

Read first time 01/24/13.   Referred to Committee on Health Care .

     AN ACT Relating to transparency in patient billing; and amending RCW 70.01.030 and 70.01.040.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 70.01.030 and 2009 c 529 s 1 are each amended to read as follows:
     (1) Health care providers licensed under Title 18 RCW and health care facilities licensed under Title 70 RCW shall provide the following to a patient upon request:
     (a) ((An)) A meaningful estimate of fees and charges related to a specific service, visit, or stay, that can assist the patient in understanding charges that may be owed prior to meeting a deductible; and
     (b) Information regarding other types of fees or charges a patient may receive in conjunction with their visit to the provider or facility. ((Hospitals licensed under chapter 70.41 RCW may fulfill this requirement by providing a statement and contact information as described in RCW 70.41.400.))
     (2) Providers and facilities listed in subsection (1) of this section may, after disclosing estimated charges and fees to a patient, refer the patient to the patient's insurer, if applicable, for specific information on the insurer's charges and fees, any cost-sharing responsibilities required of the patient, and the network status of ancillary providers who may or may not share the same network status as the provider or facility.
     (3) ((Except for hospitals licensed under chapter 70.41 RCW,)) Providers and facilities listed in subsection (1) of this section shall post a sign in patient registration areas containing at least the following language: "Information about the estimated charges of your health services is available upon request. Please do not hesitate to ask for information."
     (4) Providers and facilities listed in subsection (1) of this section shall post charges for common procedures on a consumer friendly web site. The charges must be displayed for an uninsured consumer and for consumers covered by the provider's top three carriers as determined by enrollment;
     (a) The charges by providers for common procedures must include, but are not limited to, charges for an office visit, including a separate facility fee as defined in RCW 70.01.040 if applicable, and must be displayed for an uninsured consumer and for consumers covered by the provider's top three carriers as determined by enrollment;
     (b) The charges by facilities for common procedures must include the information available on the hospital association web site as well as common outpatient procedures, and must include the facility fee as defined in RCW 70.01.040 if applicable, and must be displayed for an uninsured consumer and for consumers covered by the facilities' top three carriers as determined by enrollment.
     (5) The department of health shall monitor the development and implementation of the consumer information and report to the legislature on the progress in providing consumer transparency.

Sec. 2   RCW 70.01.040 and 2012 c 184 s 1 are each amended to read as follows:
     (1) Prior to the delivery of nonemergency services, a provider-based clinic that charges a facility fee shall provide a notice to any patient that the clinic is licensed as part of the hospital and the patient may receive a separate charge or billing for the facility component, which may result in a higher out-of-pocket expense.
     (2) Each health care facility must post prominently in locations easily accessible to and visible by patients, including its web site, a statement that the provider-based clinic is licensed as part of the hospital and the patient may receive a separate charge or billing for the facility, which may result in a higher out-of-pocket expense.
     (3) Beginning January 1, 2014, each provider-based clinic described in subsection (1) of this section and each facility licensed under Title 70 RCW must post the charges to the web site, as required in RCW 70.01.030.
     (4) Nothing in this section applies to laboratory services, imaging services, or other ancillary health services not provided by staff employed by the health care facility.
     (((4))) (5) As part of the year-end financial reports submitted to the department of health pursuant to RCW 43.70.052, all hospitals with provider-based clinics that bill a separate facility fee shall report:
     (a) The number of provider-based clinics owned or operated by the hospital that charge or bill a separate facility fee;
     (b) The number of patient visits at each provider-based clinic for which a facility fee was charged or billed for the year;
     (c) The revenue received by the hospital for the year by means of facility fees at each provider-based clinic; and
     (d) The range of allowable facility fees paid by public or private payers at each provider-based clinic.
     (((5))) (6) For the purposes of this section:
     (a) "Facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses.     
     (b) "Provider-based clinic" means the site of an off-campus clinic or provider office located at least two hundred fifty yards from the main hospital buildings or as determined by the centers for medicare and medicaid services, that is owned by a hospital licensed under chapter 70.41 RCW or a health system that operates one or more hospitals licensed under chapter 70.41 RCW, is licensed as part of the hospital, and is primarily engaged in providing diagnostic and therapeutic care including medical history, physical examinations, assessment of health status, and treatment monitoring. This does not include clinics exclusively designed for and providing laboratory, x-ray, testing, therapy, pharmacy, or educational services and does not include facilities designated as rural health clinics.