2018-S AMH CODY GAVI 3

SHB 2018 - H AMD to H AMD (2018-S AMH DYER H2836.2)298 FAILED

By Representative Cody  3-18-97

     On page 49 of the amendment, after line 36, insert the following:

APART IV--HEALTH PLAN LIABILITY

NEW SECTION. Sec 401.  A new section is added to chapter 48.43 RCW to read as follows:

     (1) No public or private health carrier subject to the jurisdiction of the state of Washington may propose, issue, sign, or renew an agreement of any kind, including an enrollee service agreement, that contains a clause or language whose effect, in any way, is to disclaim liability for the care delivered or not delivered to an enrollee because of a decision of the health carrier as to whether the care was a covered service, medically necessary, economically provided, medically appropriate, or similar consideration.

     (2) No public or private health carrier subject to the jurisdiction of the state of Washington may propose, issue, sign, or renew an agreement of any kind, including an enrollee service agreement, that contains a clause or language whose effect, in any way, is to shift liability to the provider or the patient, or both, for the care delivered or not delivered in material part because of a payment or other related decision of the health carrier.  A clause is a violation of this subsection if, by way of illustration and not limitation, it says that the decision to obtain care is between the provider and the patient, failing to acknowledge the role of payment in such decisions.

     (3) Nothing in this section is to be construed to create new liability on anyone for the health carrier's payment or related decisions.  The intent of this section is only to prevent health carriers from disclaiming or shifting any existing liability to either providers or patients, or both."

Renumber remaining parts and sections consecutively, correct internal references accordingly, correct the table of contents accordingly, and correct the title accordingly.

EFFECT:  Currently, contracts between providers and health carriers (insurers and managed care plans) may address potential liability issues regarding the relationships between the providers and the carriers.  This amendment prohibits health carriers from shifting liability for their decisions not to pay for health services to the provider or patient.