2SSB 5596 -
By Committee on Health Care & Wellness
NOT CONSIDERED 03/06/2008
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 A new section is added to chapter 48.43 RCW
to read as follows:
(1)(a) Except as provided in (b) of this subsection, a health
carrier may not develop and use a payment methodology that would result
in a payment to a chiropractor under a payment or billing code in an
amount less than a payment to a different provider licensed under Title
18 RCW who is being paid under the same payment or billing code. For
payment methodologies that are developed and used after January 1,
2009, it is presumed that payment or billing codes that apply only to
health care services provided by chiropractors are not in compliance
with this requirement unless the carrier shows to the commissioner's
satisfaction that the payment or billing codes are used only to achieve
the purposes permitted under (b) of this subsection.
(b) This section does not affect a health carrier's:
(i) Implementation of a health care quality improvement program to
promote cost-effective and clinically efficacious health care services,
including but not limited to pay-for-performance payment methodologies
and other programs fairly applied to all health care providers licensed
under Title 18 RCW that are designed to promote evidence-based and
research-based practices; or
(ii) Health care provider contracting to comply with RCW 48.43.515
and rules adopted by the commissioner establishing provider network
adequacy standards.
(c) This section does not, and may not be construed to:
(i) Require the payment of provider billings that do not meet
billing and claim payment standards set forth in rules adopted by the
commissioner;
(ii) Require any health plan to include coverage of any condition;
or
(iii) Expand the scope of practice for any health care provider.
(2) This section applies only to payment methodologies developed or
used on and after January 1, 2009."
Correct the title.
EFFECT: The amendment:
(1) Deletes a prohibition related to paying lesser amounts for
chiropractic services that are substantially similar to services
provided by another profession (and retains the prohibition against
paying chiropractors less than a different provider is paid under the
same billing code);
(2) Adds that billing codes developed after January 1, 2009, that
apply only to chiropractic services are presumed to be out of
compliance, unless the codes are shown to be for quality improvement or
network adequacy purposes (see below);
(3) Adds that this payment requirement does not affect:
(a) The health carrier's implementation of health care quality
improvement programs, including pay-for-performance payment
methodologies and other programs fairly applied to all providers; or
(b) Contracting to comply with network adequacy requirements; and
(4) Adds these changes do not require payment of billings that do
not meet Insurance Commissioner standards, do not require coverage of
any condition, and do not expand any scope of practice.