H-3632.1 _______________________________________________
HOUSE BILL 2903
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State of Washington 55th Legislature 1998 Regular Session
By Representatives Murray, Cody, Costa, Ogden, Ballasiotes, Anderson and Dickerson
Read first time 01/21/98. Referred to Committee on Health Care.
AN ACT Relating to the prohibition of certain financial incentives given to health providers in order to promote the denial of medical care in health carriers; adding new sections to chapter 48.43 RCW; and creating a new section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. The legislature finds that health carriers employ various payment schemes designed to provide consumers with access to preventative care and other medically appropriate health care. The legislature finds, however, that certain financial payment schemes or incentives may deny, withhold, delay, or limit consumer access to medically appropriate health care. Consumers must be guaranteed access to covered, medically appropriate services by eliminating inappropriate financial incentives.
NEW SECTION. Sec. 2. No health carrier nor provider network or organization shall use payment methodologies, such as bonuses, incentives, or withholding of financial compensation, that directly or indirectly encourage any physician, nurse, or other licensed or certified provider or caregiver to overtreat patients, or deny, delay, or limit medically appropriate care to which enrollees or patients are entitled. This section does not prohibit a health carrier from using capitated rates.
NEW SECTION. Sec. 3. Where capitation is used for an individual provider, it shall only apply to services directly provided by that provider. The contracting health carrier shall ensure that appropriate safeguards, such as reinsurance or stop-loss coverage, are used when individual providers or provider groups are capitated or when providers are placed at substantial financial risk.
NEW SECTION. Sec. 4. No health carrier shall discharge, demote, terminate a contract with, deny privileges to, or otherwise sanction a physician, nurse, or other licensed or certified caregiver, for reporting a violation of section 2 of this act.
NEW SECTION. Sec. 5. The office of the insurance commissioner is empowered to issue civil and administrative penalties, seek injunctive relief, or bring an action to revoke or suspend the license of a health carrier found in violation of section 2 of this act. Individual policyholders or subscribers may bring an action in superior court to require their health care service contractor or health maintenance organization comply with the provisions of chapter . . ., Laws of 1998 (this act).
NEW SECTION. Sec. 6. Sections 2 through 5 of this act are each added to chapter 48.43 RCW.
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