S-1957

AN ACT Relating to chiropractic peer review; and adding new sections to chapter 18.26 RCW.

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

NEW SECTION. Sec. 1. Unless the context clearly requires otherwise, the definitions in this section apply throughout sections 2 through 7 of this act.

(1) "Accepted standards" means those standards of practice, skill, and treatment that are recognized by a reasonably prudent chiropractor as being acceptable under similar conditions and circumstances.

(2) "Appropriate chiropractic treatment" means treatment and other services performed or ordered, in connection with a substantiated and properly documented condition, which would appear to a reasonably prudent chiropractor to be consistent with the diagnosis or analysis presented.

(3) "Excessive" fees or costs means charges for services that are unnecessary or unreasonable in the judgment of the peer review committee or reviewing subcommittee.

(4) "Patient" means an individual who receives chiropractic evaluation or treatment, or both.

(5) "Peer review committee" means the committee established under section 2 of this act, or any subcommittee of the peer review committee duly empowered to act for the committee.

(6) "Peer review proceeding" or "peer review" means an evaluation, based on accepted standards, by the peer review committee, of the appropriateness, quality, utilization, and cost of health services provided to a patient. Peer review does not include matters related to the licensing, discipline, or scope of practice of any health care profession.

(7) "Properly utilized services" means appropriate services rendered or ordered, including the frequency and duration of such services, which are documented as being necessary and reasonable by clinical records and reports or by other facts, presentations, or evidence reviewed by the peer review committee.

(8) "Services rendered" means all services provided to a patient.

NEW SECTION. Sec. 2. The board shall appoint the peer review committee, which shall be constituted as follows: The chair of the peer review committee shall be a member of the board and shall not vote except to break a tie; one chiropractor from each congressional district; one independent member representative of the health insurance industry. The term of appointment of peer review committee members shall be one year, and no member shall serve more than two consecutive terms. The board may appoint additional pro tem members as necessary. Chiropractor members shall have at least five years of active practice in this state. The board shall adopt rules establishing other qualifications for appointment to the peer review committee, including rules to avoid conflict of interest or the appearance of conflict of interest.

NEW SECTION. Sec. 3. (1) A patient, a patient's representative, an insurer, an agency of the state of Washington, or a chiropractor may request a peer review proceeding by submitting an inquiry about services rendered to a patient by a chiropractor. The board shall, in its discretion, determine whether the inquiry should be reviewed as a peer review proceeding, as a matter for possible voluntary mediation, or as a disciplinary proceeding. Peer review shall not be used to replace the independent medical/chiropractic examination.

(2) If the board determines that the inquiry should be reviewed as a peer review proceeding, the board shall assess the requesting party a preliminary fee to cover the estimated cost of the peer review proceeding. Upon completion of the proceeding, the board may adjust the preliminary fee, assessing any party part or all of the cost of the peer review proceeding. In its discretion, the board may waive all or part of the costs of the proceeding. The board shall assess fees for peer review at a sufficient level to defray administrative costs.

(3) Request for peer review constitutes consent to submission by any party of all necessary records and other information concerning the health care services reviewed. All information acquired by the board or by the peer review committee shall be subject to the disclosure and confidentiality protections provided in RCW 4.24.250.

NEW SECTION. Sec. 4. (1) The peer review committee may review matters regarding the appropriateness, quality, utilization, or cost of chiropractic services rendered. The peer review committee on each review shall include in its findings a determination whether appropriate chiropractic treatment was rendered, whether the services rendered were properly utilized services, whether treatment or services rendered or ordered were appropriate in accordance with accepted standards, and whether the fees charged were excessive or not.

(2) If the peer review proceeding was conducted by a subcommittee of the peer review committee, any decision or finding of the subcommittee shall be approved or disapproved by the entire committee.

(3) The peer review committee shall submit to all parties and to the board a decision setting forth the committee's findings and recommendations.

(4) Any party may appeal the decision to the board. The board, on the record of the peer review committee, may return the proceeding with recommendations to the committee for reconsideration, may initiate disciplinary proceedings, or may approve the decision of the peer review committee, or may take any combination of the above actions.

NEW SECTION. Sec. 5. The peer review committee shall file with the board a complaint against a chiropractor if the committee determines that reasonable cause exists to believe the chiropractor has committed unprofessional conduct. The peer review committee shall transmit all information pertinent to the complaint to the board. Such information shall be confidential and shall be used solely for disciplinary purposes.

NEW SECTION. Sec. 6. The peer review committee shall prepare an annual summary of the findings, decisions, and results of the peer review proceedings conducted during the prior calendar year, which shall be made available to the public. Names or information identifying particular patients shall not be included in public reports or summaries.

NEW SECTION. Sec. 7. The board may adopt rules necessary and appropriate to implement sections 1 through 6 of this act.

NEW SECTION. Sec. 8. Sections 1 through 7 of this act are each added to chapter 18.26 RCW.