AN ACT Relating to computerized medical
insurance eligibility and beneficiary coverage information available to the
department of social and health services from medical insurance payers; and
adding a new chapter to Title 74 RCW.
BE
IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1.
The legislature finds that:
(1) Simplification in the administration of
payment of health benefits is important for the state, providers, and private
insurers;
(2) The state, providers, and private insurers
should take advantage of all opportunities to streamline operations through automation
and the use of common computer standards; and
(3) It is in the best interests of the state,
providers, and private insurers to identify all third parties that are
obligated to cover the cost of health care coverage of joint beneficiaries.
Therefore, the legislature declares that to
improve the coordination of benefits between the department of social and
health services and private insurers to ensure that medical insurance benefits
are properly utilized, a transfer of uniform information from the department of
social and health services to Washington state private insurers should be
instituted.
NEW SECTION. Sec. 2.
For the purposes of this chapter:
(1) "Health insurance coverage"
includes any coverage under which medical services are provided by an employer
or a union whether that coverage is provided through a self-insurance program,
under the employee retirement income security act of 1974, a commercial insurer
pursuant to chapters 48.20 and 48.21 RCW, a health care service contractor
pursuant to chapter 48.44 RCW, or a health maintenance organization pursuant to
chapter 48.46 RCW, and medical assistance under chapter 74.09 RCW, and the
state through this chapter.
(2) "Insurer" means a commercial
insurance company providing disability insurance under chapter 48.20 or 48.21
RCW, a health care service contractor providing health care coverage under
chapter 48.44 RCW, a health maintenance organization providing comprehensive
health care services under chapter 48.46 RCW, and shall also include any
employer or union that is providing health insurance coverage on a self-insured
basis.
(3) "Medical assistance
administration" means the division within the department of social and
health services authorized under chapter 74.09 RCW.
(4) "Computerized" means on-line or
batch processing with standardized format via magnetic tape output.
(5) "Insurance coverage" means
subscriber and beneficiary eligibility and benefit coverage data.
(6) "Joint beneficiary" is a resident
of Washington state who has private insurance coverage and is a recipient of
public assistance benefits under chapter 74.09 RCW.
NEW SECTION. Sec. 3.
(1) The medical assistance administration shall provide routine and periodic
computerized information to private insurers regarding client eligibility and
coverage information. Private insurers shall use this information to identify
joint beneficiaries. Identification of joint beneficiaries shall be
transmitted to the medical assistance administration. The medical assistance
administration shall use this information to improve accuracy and currency of
health insurance coverage and promote improved coordination of benefits.
(2) To the maximum extent possible, necessary
data elements and a compatible data base shall be developed by affected health
insurers and the medical assistance administration. The medical assistance
administration shall establish a representative group of insurers and state
agency representatives to develop necessary technical and file specifications
to promote a standardized data base. The data base shall include elements
essential to the medical assistance administration and its population's
insurance coverage information.
(3) If the state and private insurers enter
into other agreements regarding the use of common computer standards, the data
base identified in this section shall be replaced by the new common computer
standards.
(4) The information provided will be of
sufficient detail to promote reliable and accurate benefit coordination and
identification of individuals who are also eligible for medical assistance
administration programs.
(5) The frequency of updates will be mutually
agreed to by each insurer and the medical assistance administration based on
frequency of change and operational limitations. In no event shall the
computerized data be provided less than semiannually.
(6) The insurers and the medical assistance
administration shall safeguard and properly use the information to protect
records as provided by law, including but not limited to chapters 42.48, 74.09,
74.04, and 70.02 RCW, RCW 42.17.310, and 42 U.S.C. Sec. 1396a and 42 C.F.R.
Sec. 43 et seq. The purpose of this exchange of information is to improve
coordination and administration of benefits and ensure that medical insurance
benefits are properly utilized.
(7) The medical assistance administration shall
target implementation of this chapter to those private insurers with the
highest probability of joint beneficiaries.
NEW SECTION. Sec. 4.
Sections 1 through 3 of this act shall constitute a new chapter in Title 74
RCW.
