SENATE BILL REPORT

 

 

                                   ESB 5169

 

 

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

 

      Senate Hearing Date(s):January 26, 1989; February 2, 1989; February 6, 1989

 

Majority Report:  Do pass as amended and be referred to Committee on Ways & Means.

      Signed by Senators Craswell, Vice Chairman; Bailey, Stratton, Vognild.

 

      Senate Staff:Jan Sharar (786-7472)

                  February 7, 1989

 

 

Senate Committee on Ways & Means

 

      Senate Hearing Date(s):March 16, 1989; March 17, 1989

 

Majority Report:  Do pass as amended.

      Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Hayner, Lee, Newhouse, Owen, Saling.

 

      Senate Staff:Karen Hayes (786-7711)

                  March 2, 1990

 

 

House Committe on Human Services

 

 

                      AS PASSED SENATE, JANUARY 22, 1990

 

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 for expenses provided by a hospital for mentally ill or 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.

 

Under certain circumstances, DSHS may recover monies from estates of those 65 years of age or older if the estate's value is more than $50,000.  DSHS is often unable to recover monies because of the $50,000 exclusion.

 

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 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 to the department a copy of the written settlement agreement.  The department may also request and examine the attorney's records of the fees and costs charged to the client in the matter.

 

Where there are surviving adult children, the department may recover medical costs from estates of those 65 or older if the value of the estate is over $50,000.

 

DSHS authority to audit medical provider's 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.

 

Appropriation:    none

 

Revenue:    none

 

Fiscal Note:      available

 

Senate Committee - Testified: CHILDREN & FAMILY SERVICES: Dave Hogan, DSHS

 

Senate Committee - Testified: WAYS & MEANS:  Dave Hogan, DSHS (pro); Becky Bogard, Medical Lab Group; Cliff Webster, Washington State Medical Association; Dave Broderick, Hospital Association; Jeff Larsen, Washington Osteopathic Medical Association

 

 

HOUSE AMENDMENT:

 

References to the year of the act are changed from 1989 and 1990.  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.