2840‑S AMH CODY PERR 201

SHB 2840 ‑ H AMD 288 SCOPE & OBJECT 2/13/96

By Representatives Dellwo and Cody

     On page 2, after line 29, insert the following:

     "NEW SECTION. Sec 3.  A new section is added to chapter 48.43 RCW to read as follows:

     (1) No public or private health carrier subject to the jurisdiction of the state of Washington may propose, issue, sign, or renew an agreement of any kind, including an enrollee service agreement, that contains a clause or language whose effect, in any way, is to disclaim liability for the care delivered or not delivered to an enrollee because of a decision of the health carrier as to whether the care was a covered service, medically necessary, economically provided, medically appropriate, or similar consideration.

     (2) No public or private health carrier subject to the jurisdiction of the state of Washington may propose, issue, sign, or renew an agreement of any kind, including an enrollee service agreement, that contains a clause or language whose effect, in any way, is to shift liability to the provider or the patient, or both, for the care delivered or not delivered in material part because of a payment or other related decision of the health carrier.  A clause is a violation of this subsection if, by way of illustration and not limitation, it says that the decision to obtain care is between the provider and the patient, failing to acknowledge the role of payment in such decisions.

     (3) Nothing in this section is to be construed to create new liability on anyone for the health carrier's payment or related decisions.  The intent of this section is only to prevent health carriers from disclaiming or shifting any existing liability to either providers or patients, or both."

     Correct the title accordingly.

EFFECT:  Prohibits health carriers from shifting liability for their decisions not to pay for health services to the provider or patient.