| Washington State House of Representatives Office of Program Research |
BILL ANALYSIS |
| Health Care & Wellness Committee | |
2SSB 5596
This analysis was prepared by non-partisan legislative staff for the use of legislative members in
their deliberations. This analysis is not a part of the legislation nor does it constitute a
statement of legislative intent.
Brief Description: Requiring fair payment for chiropractic services.
Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Franklin, Benton, Kline, Poulsen, Keiser and Roach).
Brief Summary of Second Substitute Bill |
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Hearing Date: 2/21/08
Staff: Chris Cordes (786-7103).
Background:
Health carriers, including disability insurers, health care service contractors, and health
maintenance organizations, must include every category of provider to provide services for
conditions covered by the plan. Under Insurance Commissioner rules, health carriers may place
reasonable limits on individual services rendered by specific categories of providers, but may not
exclude an entire category of provider if providing a covered service is within the provider's
scope of practice.
Insurance Commissioner's rules require health carriers to file sample contract forms proposed for
use with their participating providers and facilities. However, the health carrier does not need to
submit information about payment rates or amounts or other similar proprietary information.
These rules also require health carriers to include schedules for prompt payment of providers,
but do not regulate the payment methodologies that health carriers use to reimburse for health
care services. Rates paid by health carriers may differ depending on the type of provider that
provides the covered service.
Summary of Bill:
Health carriers may not use payment methodologies that pay less for chiropractic services than
for another profession's substantially similar health care services. Health carriers may not use a
payment method that pays chiropractors less than another type of provider for the same billing
and payment code.
These provisions apply to payment methods used on and after January 1, 2009.
Appropriation: None.
Fiscal Note: Requested on February 19, 2008 on 2SSB 5596, but available for PSSB 5596.
Effective Date: The bill takes effect 90 days after adjournment of session in which bill is passed.