SENATE BILL REPORT

EHB 1552

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health & Long Term Care, February 28, 2020

Title: An act relating to health care provider credentialing by health carriers.

Brief Description: Concerning health care provider credentialing by health carriers.

Sponsors: Representatives Dolan, Doglio, Fey, Senn, Appleton, Robinson, Ryu, Jinkins, Macri and Leavitt.

Brief History: Passed House: 2/17/20, 98-0.

Committee Activity: Health & Long Term Care: 2/28/20, 2/28/20 [DP, DNP, w/oRec].

Brief Summary of Bill

  • Prohibits health carriers from requiring a health care provider to submit credentialing information in a format other than through the database selected by the Office of the Insurance Commissioner.

  • Requires health carriers to reimburse a health care provider for covered health care services provided to the carrier's enrollees during the credentialing process under certain circumstances.

SENATE COMMITTEE ON HEALTH & LONG TERM CARE

Majority Report: Do pass.

Signed by Senators Cleveland, Chair; Randall, Vice Chair; O'Ban, Ranking Member; Conway, Dhingra, Frockt, Keiser, Rivers and Van De Wege.

Minority Report: Do not pass.

Signed by Senator Muzzall.

Minority Report: That it be referred without recommendation.

Signed by Senator Becker.

Staff: Evan Klein (786-7483)

Background: Provider credentialing is the process that insurance carriers use to collect, verify, and assess whether a health care provider meets relevant licensing, education, and training requirements. The Office of the Insurance Commissioner (OIC) is required to designate a lead organization to develop a uniform electronic process for collecting and transmitting the necessary provider-supplied data to support credentialing, admitting privileges, and other related processes. The OIC selected OneHealthPort as the lead organization, which developed the credentialing database, ProviderSource.

Health care providers are required to submit credentialing applications to ProviderSource and health carriers are required to accept and manage credentialing applications from the database. A health carrier must approve or deny a credentialing application submitted to the carrier no later than 90 days after receiving a complete application from a health care provider.

Beginning June 1, 2020, the average response time for the health carrier to make a determination regarding the approval or denial of a provider's credentialing application may not exceed 60 days. If there is a credentialing delegation arrangement between a facility that employs health care providers and a health carrier, then the single credentialing database is not required to be used and the timelines do not apply.

Summary of Bill: A health carrier may not require a health care provider to submit credentialing information in any format other than through database selected by the OIC for purposes of collecting and transmitting credentialing information. This requirement does not apply to health care entities that utilize credentialing delegation arrangements.

If a carrier approves a provider's credentialing application, upon completion of the process the carrier must reimburse the provider for covered services provided to the carrier's enrollees under the following circumstances:

The carrier must reimburse the provider at the contracted rate that the provider would have been paid at the time the services were provided if the provider were fully credentialed by the carrier. The carrier is not required to reimburse for services:

Appropriation: None.

Fiscal Note: Available.

Creates Committee/Commission/Task Force that includes Legislative members: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony: PRO: When provider offices need to hire a new physician, the provider must get credentialed by a carrier to receive reimbursement. This process can take up to 90 days. During that time, the provider and their office cannot get paid for services being provided to enrollees, which leaves offices in a difficult financial situation. This bill will ensure providers can get paid for services provided during the credentialing process. The focus had been on the timeline for credentialing, but the focus has changed to ensure providers can be retroactively paid.

OTHER: There is a question about what constitutes the starting point for retroactive reimbursement, and a possible desire for some clarity about when a contract has been completed. The concern is that a provider might in good faith believe their application is complete, but that an insurer may wait to respond to the provider and later notify them the application is not complete. This would again leave providers in a situation where they are unable to receive payment for certain services provided. The bill before the committee is otherwise well worked and a good compromise. The hope is to keep this bill moving, but potentially clarify when a contract is deemed completed as the bill moves to the floor.

Persons Testifying: PRO: Representative Laurie Dolan, Prime Sponsor; Sean Graham, Washington State Medical Association. OTHER: Lisa Thatcher, Washington State Hospital Association; Chris Bandoli, Association of Washington Healthcare Plans.

Persons Signed In To Testify But Not Testifying: No one.