HOUSE BILL REPORT

                  HB 2223

             As Reported By House Committee On:

                         Health Care

Title:  An act relating to health plan requirements.

Brief Description:  Revising requirements for health plans.

Sponsors:  Representatives Dyer and Backlund.

Brief History:

Committee Activity:

Health Care:  2/28/97 [DP].

HOUSE COMMITTEE ON HEALTH CARE

Majority Report:  Do pass.  Signed by 6 members:  Representatives Dyer, Chairman; Backlund, Vice Chairman; Skinner, Vice Chairman; Parlette; Sherstad and Zellinsky.

Minority Report:  Do not pass.  Signed by 4 members:  Representatives Cody, Ranking Minority Member; Murray, Assistant Ranking Minority Member; Anderson and Wood.

Staff:  Bill Hagens (786-7131).

Background:  A 1995 law requires health carriers to permit every category of health care provider, within the scope of practice, to provide health services for conditions included in the Basic Health Plan services as long as participating providers abide by carrier requirements regarding utilization review, cost containment, management, and clinical efficacy.

Proponents believe that this requirement is excessively affecting consumer choice by including a broad range of providers in their coverage, thus unnecessarily increasing the cost of insurance.

This provision is not in effect because of pending legal action.

Summary of Bill:  The requirement that health carriers permit every category of health care provider to provide health services is modified to apply only when a carrier is offering the model Basic Health Plan benefits package, as required by law.

Appropriation:  None.

Fiscal Note:  Not requested.

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

Testimony For:  Under the current interpretation of the law, the requirement to include all types of provider care in practically all coverage is very costly and limits individual choice.

Testimony Against:  The present managed care environment continues to limit people=s ability to include the type of provider they want in their coverage.  The current law, once successfully litigated, is the only protection the people have to ensure access to their providers.

Testified:  None.