1046-S.E AMS QUIG S3324.2

ESHB 1046 - S AMD TO S AMD (S-3275.3/95) - 401

By Senator Quigley

    On page 9, after line 19 of the amendment, insert the following:

    "NEW SECTION. Sec. 9.  A new section is added to chapter 48.43 RCW to read as follows:

    Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1996, shall:

    (1) Permit every health care provider to provide health services or care for conditions included in any health plan offered by that carrier in every market area determined by the commissioner in which a carrier's market share of premiums is greater than thirty percent to the extent that:

    (a) The provision of such health services or care is within the health care providers' permitted scope of practice; and

    (b) The providers agree to abide by standards related to:

    (i) Provision, utilization review, and cost containment of health services;

    (ii) Management and administrative procedures; and

    (iii) Provision of cost-effective and clinically efficacious health services.

    (2) Annually report the names and addresses of all officers, directors, or trustees of the health carrier during the preceding year, and the amount of wages, expense reimbursements, or other payments to such individuals."

    Renumber the remaining sections consecutively and correct internal references accordingly.

EFFECT:  Requires that health carriers allow participation of any provider willing and able to meet the terms and conditions of the plan in market areas where the carrier controls more than 30% of the market.

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