1725-S AMH GREE ELGE 081

SHB 1725 - H AMD 308

By Representative Green

ADOPTED 03/05/2011

    On page 5, after line 8, insert the following:

    "NEW SECTION. Sec. 4. A new section is added to chapter 51.18 to read as follows:

    Payment by an employer for direct primary care services as defined in RCW 48.150.010 does not disqualify: (a) An employer from participating in the retrospective rating plan; (b) a group sponsor from promoting a retrospective rating plan; or (c) a plan administrator from administering a retrospective rating plan."

    Renumber the remaining sections consecutively and correct any internal references accordingly.

    On page 8, after line 24, insert the following:

    "NEW SECTION. Sec. 5. A new section is added to chapter 51.36 RCW to read as follows:

    The director shall adopt rules to assure an injured worker may receive care from a health care provider who furnishes primary care services through a direct agreement in compliance with chapter 48.150 RCW.  Any billing rule requiring a provider to bill for services does not apply to a direct practice. However, the department may require a direct practice provider to comply with any other standards required to provide care under this title. The department may adopt rules requiring a direct practice that provides care under this title to provide such information as the department requires to establish rates for state fund employers and any refunds or assessments for employers or groups participating in the retrospective rating plan. The department may also adopt rules regarding direct practice fees to assure that workers are not paying for benefits under this title, other than what is permitted under RCW 51.16.140 and 51.32.073. For purposes of this subsection, "direct practice" shall have the meaning in RCW 48.150.010."

    Renumber the remaining sections consecutively and correct any internal references accordingly.

    Correct the title.

EFFECT: Requires the Department of Labor and Industries (Department) to adopt rules to assure an injured worker may receive care from a direct practice provider.  Provides that any billing rule requiring a provider to bill for services does not apply to a direct practice; however, the Department may require a direct practice provider to comply with other standards to provide care of injured workers.  Allows the Department to adopt rules requiring direct practices to provide information to the Department for the establishment of State Fund employer rates and retrospective rating plan refunds or assessments. Allows the Department to adopt rules regarding direct practice fees to assure that workers are not paying for industrial insurance benefits, other than what is permitted by law.  

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