FINAL BILL REPORT

SB 5169

                              C 100 L 90

BYSenators Smith and Stratton; by request of Department of Social and Health Services

Providing for revenue collection by the department of social and health services.

Senate Committee on Children & Family Services and Committee on Ways & Means

House Committe on Human Services

SYNOPSIS AS ENACTED

BACKGROUND:

The Division of Revenue of the Department of Social and Health Services (DSHS) is responsible for collecting monies owed to the department.

DSHS provides medical assistance to persons suffering injuries caused by the wrongful acts of others.  DSHS currently recovers its expenses for medical costs from third parties, but may not recover expenses provided by a hospital for the mentally ill or by a care center for the developmentally disabled.

DSHS audits medical providers' records to establish "usual and customary" charges by examining only the records for which services were rendered by a provider and reimbursed by the state.  The concern is that other records must be examined in order to establish "usual and customary" fees.

Wrongful disclosure of patient records is punishable as a gross misdemeanor.

SUMMARY:

The Department of Social and Health Services (DSHS) recovery rights from third parties are broadened to include costs provided by a mental health department at a hospital or care center for the developmentally disabled.

The Secretary of DSHS must give written consent to any settlement or judgment of a tort claim which reduces or alters the terms of a lien.

Attorneys representing persons who have sustained injuries due to the negligent action of a third party and have received health care assistance from DSHS are required to notify DSHS before commencing a lawsuit against the third party or negotiating a settlement.  Attorneys are required to give DSHS 30 days notice before a judgment, award or settlement becomes final.

The portion of attorneys' fees that the department must pay is based upon the fees and costs approved by the court, or when there is no court approval the portion is based on the written agreement between the attorney and the client, which establishes fees and costs.  If the fees and costs have been approved by the court, the department may challenge them in court.  If fees and costs are not approved by the court, the attorney must send a copy of the written settlement agreement to the department.  The department may also request and examine the attorney's records of the fees and costs charged to the client in the matter.

DSHS authority to audit medical providers' records is limited to such random provider records of accounts billed and received, to determine whether or not the charges are usual and customary of the prevailing charges in the area.

Any overpayment discovered as a result of an audit shall be offset by any underpayments discovered in the same audit.

Unless patients are public assistance recipients or applicants, their names shall not be provided to the department.  The penalty for wrongful disclosure of patient records by the department is raised from a gross misdemeanor to a class C felony.

VOTES ON FINAL PASSAGE:

     Senate   46    0

     House 93  1 (House amended)

     Senate   46    0 (Senate concurred)

EFFECTIVE:June 7, 1990