HOUSE BILL REPORT
SB 5159
As Reported by House Committee On:
Health Care
Title: An act relating to fees for performing independent reviews of health care disputes.
Brief Description: Developing a schedule of fees for performing independent reviews of health care disputes.
Sponsors: Senator Keiser.
Brief History:
Health Care: 3/17/05, 3/18/05 [DP].
Brief Summary of Bill |
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HOUSE COMMITTEE ON HEALTH CARE
Majority Report: Do pass. Signed by 13 members: Representatives Cody, Chair; Campbell, Vice Chair; Morrell, Vice Chair; Bailey, Ranking Minority Member; Alexander, Appleton, Clibborn, Green, Hinkle, Lantz, Moeller, Schual-Berke and Skinner.
Minority Report: Do not pass. Signed by 1 member: Representative Curtis, Assistant Ranking Minority Member.
Staff: Chris Blake (786-7392).
Background:
Health carriers that offer health plans must have a comprehensive grievance process for
addressing complaints from plan enrollees about customer service or the quality or
availability of a health service. Where the health carrier's grievance process has issued an
unfavorable decision to an enrollee or it has exceeded mandated timelines without good
cause, the enrollee may seek review by a certified independent review organization. This
review is only available for those complaints pertaining to payment for health care services or
the denial, modification, reduction, or termination of coverage for health care services. The
Office of the Insurance Commissioner assigns an independent review organization to a
complaint on a rotational basis.
The Department of Health (Department) is responsible for adopting rules to certify
independent review organizations. These rules relate to ensuring: the confidentiality of
medical records; the qualifications of medical reviewers; the absence of conflicts of interest;
and the fairness and timeliness of the proceedings.
Summary of Bill:
By January 1, 2006, the Department must develop a fee schedule that establishes reasonable
maximum fees that may be charged to health carriers by an independent review organization
when conducting reviews of complaints. The Department is required to adopt rules requiring
that independent review organizations assess fees to health carriers consistent with the
maximum fee schedule.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of session in which bill is passed.
Testimony For: This bill will set a fair and consistent fee for the independent review organizations to charge.
Testimony Against: None.
Persons Testifying: Senator Keiser, prime sponsor; and Bonnie King, Department of Health.