BILL REQ. #: H-0543.1
State of Washington | 62nd Legislature | 2011 Regular Session |
Read first time 02/09/11. Referred to Committee on Health Care & Wellness.
AN ACT Relating to maintaining hospital privileges; and amending RCW 48.44.020.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 48.44.020 and 2008 c 303 s 2 are each amended to read
as follows:
(1) Any health care service contractor may enter into contracts
with or for the benefit of persons or groups of persons which require
prepayment for health care services by or for such persons in
consideration of such health care service contractor providing one or
more health care services to such persons and such activity shall not
be subject to the laws relating to insurance if the health care
services are rendered by the health care service contractor or by a
participating provider.
(2) The commissioner may on examination, subject to the right of
the health care service contractor to demand and receive a hearing
under chapters 48.04 and 34.05 RCW, disapprove any individual or group
contract form for any of the following grounds:
(a) If it contains or incorporates by reference any inconsistent,
ambiguous or misleading clauses, or exceptions and conditions which
unreasonably or deceptively affect the risk purported to be assumed in
the general coverage of the contract; or
(b) If it has any title, heading, or other indication of its
provisions which is misleading; or
(c) If purchase of health care services thereunder is being
solicited by deceptive advertising; or
(d) If it contains unreasonable restrictions on the treatment of
patients; or
(e) If it violates any provision of this chapter; or
(f) If it fails to conform to minimum provisions or standards
required by regulation made by the commissioner pursuant to chapter
34.05 RCW; or
(g) If any contract for health care services with any state agency,
division, subdivision, board, or commission or with any political
subdivision, municipal corporation, or quasi-municipal corporation
fails to comply with state law.
(3) In addition to the grounds listed in subsection (2) of this
section, the commissioner may disapprove any contract if the benefits
provided therein are unreasonable in relation to the amount charged for
the contract. Rates, or any modification of rates effective on or
after July 1, 2008, for individual health benefit plans may not be used
until sixty days after they are filed with the commissioner. If the
commissioner does not disapprove a rate filing within sixty days after
the health care service contractor has filed the documents required in
RCW 48.44.017(2) and any rules adopted pursuant thereto, the filing
shall be deemed approved.
(4)(a) Every contract between a health care service contractor and
a participating provider of health care services shall be in writing
and shall state that in the event the health care service contractor
fails to pay for health care services as provided in the contract, the
enrolled participant shall not be liable to the provider for sums owed
by the health care service contractor. Every such contract shall
provide that this requirement shall survive termination of the
contract.
(b) No participating provider, insurance producer, trustee, or
assignee may maintain any action against an enrolled participant to
collect sums owed by the health care service contractor.
(5) A contract between a health care service contractor and a
participating provider, or any document incorporated by reference into
such a contract including, but not limited to, credentialing guidelines
and policy guidelines, may not require a participating provider to
maintain active staff privileges at a hospital when that participating
provider's hospitalized patients are solely admitted to, and cared for
by, hospitalists or other hospital-based health care providers who are
participating providers of the health care service contractor.