BILL REQ. #:  H-1569.1 

Read first time 02/05/2007.   Referred to Committee on Commerce & Labor.

     AN ACT Relating to medical providers receiving payment for authorized treatment in industrial insurance claims; and amending RCW 51.36.080.

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

Sec. 1   RCW 51.36.080 and 1998 c 245 s 104 are each amended to read as follows:
     (1) All fees and medical charges under this title shall conform to the fee schedule established by the director and shall be paid within sixty days of receipt by the department of a proper billing in the form prescribed by department rule or sixty days after the claim is allowed by final order or judgment, if an otherwise proper billing is received by the department prior to final adjudication of claim allowance. The department shall pay interest at the rate of one percent per month, but at least one dollar per month, whenever the payment period exceeds the applicable sixty-day period on all proper fees and medical charges.
     Beginning in fiscal year 1987, interest payments under this subsection may be paid only from funds appropriated to the department for administrative purposes.
     Nothing in this section may be construed to require the payment of interest on any billing, fee, or charge if the industrial insurance claim on which the billing, fee, or charge is predicated is ultimately rejected or the billing, fee, or charge is otherwise not allowable unless the department has authorized the treatment in writing prior to rejecting the claim. If the department authorizes treatment in writing for a claim that is subsequently rejected by the department, the department shall, at no cost to the employer, reimburse a provider who provides the authorized treatment prior to the rejection of the claim.
     In establishing fees for medical and other health care services, the director shall consider the director's duty to purchase health care in a prudent, cost-effective manner without unduly restricting access to necessary care by persons entitled to the care. With respect to workers admitted as hospital inpatients on or after July 1, 1987, the director shall pay for inpatient hospital services on the basis of diagnosis-related groups, contracting for services, or other prudent, cost-effective payment method, which the director shall establish by rules adopted in accordance with chapter 34.05 RCW.
     (2) The director may establish procedures for selectively or randomly auditing the accuracy of fees and medical billings submitted to the department under this title.