Washington State House of Representatives Office of Program Research | BILL ANALYSIS |
Health Care & Wellness Committee |
ESB 5518
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 reimbursement for chiropractic services.
Sponsors: Senators Miloscia, Cleveland, Keiser, O'Ban and Fortunato.
Brief Summary of Engrossed Bill |
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Hearing Date: 2/20/18
Staff: Kim Weidenaar (786-7120).
Background:
Health carriers are prohibited from using a payment method that pays chiropractors less than another type of provider licensed under RCW Title 18 for the same physical medicine and rehabilitation code or evaluation and management code as listed in a nationally recognized code book such as the American Medical Association Current Procedural Terminology Code Book. The carrier may not circumvent the requirement by creating a chiropractor-specific code not listed in the nationally recognized code book otherwise used by the carrier for provider payment.
Health carriers are permitted to:
implement a health care quality improvement program, including pay-for performance payment methods and other programs fairly applied to all health care providers to promote evidence-based practice;
contract to comply with network adequacy standards;
pay in-network and out-of-network providers differently; and
pay differently based on geographic differences in practice costs.
Summary of Bill:
Beginning January 1, 2019, health carriers may not pay a chiropractor less than another type of provider for the same or substantially similar spinal manipulation code. The prohibition against paying a chiropractor less than another type of provider for the same physical medicine and rehabilitation code or evaluation and management code is expanded to include substantially similar codes.
A health carrier's authority to pay a chiropractor less than another provider for services provided under the same or an equivalent code based on differences in the cost of maintaining a practice or carrying malpractice insurance, under a nationally accepted payment methodology are not affected.
The Office of the Insurance Commissioner may adopt rules to implement this requirement.
Appropriation: None.
Fiscal Note: Available.
Effective Date: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section Section 1, relating to the prohibition against health carriers paying a chiropractor less than another type of provider for the same or substantially similar manipulation code or for a substantially similar physical medicine and rehabilitation code or an evaluation and management code, which takes effect January 1, 2019.