6392-S.E AMH .... H5420.1

ESSB 6392 - H AMD TO HC COMM AMD (H5311.1) 452 RULED BEYOND SCOPE AND                                                     OBJECT 3-1-96

By Representatives Cody and Murray

    On page 3, after line 35 of the amendment, insert the following:

    "NEW SECTION. Sec. 1.  INSURER DISCLAIMING LIABILITY TO PATIENTS.  (1) No health maintenance organization 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 maintenance organization as to whether the care was a covered service, medically necessary, economically provided, medically appropriate, or similar consideration.

    (2) No health maintenance organization 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 maintenance organization.  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 shall be construed to create new liability on anyone for the health maintenance organization's payment or related decisions.  The intent of this section is only to prevent health maintenance organizations from disclaiming or shifting any existing liability to either providers or patients, or both."

    Renumber the remaining sections consecutively and correct internal references accordingly.

ESSB 6392 - H AMD TO HC COMM AMD (H5311.1)

By Representative

    On page 4, line 3 of the amendment, after "through" strike "5" and insert "6"

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