BILL REQ. #:  H-4750.1 

READ FIRST TIME 02/05/04.   

     AN ACT Relating to the liability insurance program for retired primary care providers volunteering to serve low-income patients; and amending RCW 43.70.460 and 43.70.470.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 43.70.460 and 1993 c 492 s 276 are each amended to read as follows:
     (1) The department may establish a program to purchase and maintain liability malpractice insurance for retired primary care providers who provide primary health care services ((at community clinics)) to low-income patients. The following conditions apply to the program:
     (a) Primary health care services shall be provided at ((community)) clinics serving low-income patients that are public or private tax-exempt corporations or other established practice settings as defined by the department;
     (b) Primary health care services provided at the clinics shall be offered to low-income patients based on their ability to pay;
     (c) Retired primary care providers providing health care services shall not receive compensation for their services; and
     (d) The department shall contract only with a liability insurer authorized to offer liability malpractice insurance in the state.
     (2) This section and RCW 43.70.470 shall not be interpreted to require a liability insurer to provide coverage to a primary care provider should the insurer determine that coverage should not be offered to a ((physician [primary care provider])) primary care provider because of past claims experience or for other appropriate reasons.
     (3) The state and its employees who operate the program shall be immune from any civil or criminal action involving claims against clinics or ((physicians [primary care providers])) primary care providers that provided health care services under this section and RCW 43.70.470. This protection of immunity shall not extend to any clinic or primary care provider participating in the program.
     (4) The department may monitor the claims experience of retired ((physicians [primary care providers])) primary care providers covered by liability insurers contracting with the department.
     (5) The department may provide liability insurance under chapter 113, Laws of 1992 only to the extent funds are provided for this purpose by the legislature. If there are insufficient funds to support all applications for liability insurance coverage, priority shall be given to those retired primary care providers working at clinics operated by public or private tax-exempt corporations rather than clinics operated by for-profit corporations.

Sec. 2   RCW 43.70.470 and 1993 c 492 s 277 are each amended to read as follows:
     The department may establish by rule the conditions of participation in the liability insurance program by retired primary care providers at clinics utilizing retired ((physicians [primary care providers])) primary care providers for the purposes of this section and RCW 43.70.460. These conditions shall include, but not be limited to, the following:
     (1) The participating primary care provider associated with the clinic shall hold a valid license to practice as a physician under chapter 18.71 or 18.57 RCW, a naturopath under chapter 18.36A RCW, a physician assistant under chapter 18.71A or 18.57A RCW, an advanced registered nurse practitioner under chapter 18.88 RCW, a dentist under chapter 18.32 RCW, or other health professionals as may be deemed in short supply in the health personnel resource plan under chapter 28B.125 RCW. A primary care provider may include a specialist who is practicing in a primary care capacity. All primary care providers must be in conformity with current requirements for licensure as a retired primary care provider, including continuing education requirements;
     (2) The participating primary care provider shall limit the scope of practice in the clinic to primary care. Primary care shall be limited to noninvasive procedures and shall not include obstetrical care, or any specialized care and treatment. Noninvasive procedures include injections, suturing of minor lacerations, and incisions of boils or superficial abscesses. Primary dental care shall be limited to diagnosis, oral hygiene, restoration, and extractions and shall not include orthodontia, or other specialized care and treatment;
     (3) The provision of liability insurance coverage shall not extend to acts outside the scope of rendering medical services pursuant to this section and RCW 43.70.460;
     (4) The participating primary care provider shall limit the provision of health care services to primarily low-income persons provided that clinics may, but are not required to, provide means tests for eligibility as a condition for obtaining health care services;
     (5) The participating primary care provider shall not accept compensation for providing health care services from patients served pursuant to this section and RCW 43.70.460, nor from clinics serving these patients. "Compensation" shall mean any remuneration of value to the participating primary care provider for services provided by the primary care provider, but shall not be construed to include any nominal copayments charged by the clinic, nor reimbursement of related expenses of a participating primary care provider authorized by the clinic in advance of being incurred; and
     (6) The use of mediation or arbitration for resolving questions of potential liability may be used, however any mediation or arbitration agreement format shall be expressed in terms clear enough for a person with a sixth grade level of education to understand, and on a form no longer than one page in length.