SHB 2018 - H AMD TO H AMD (2018-S AMH DYER H2836.2) 342 AD 3-18-97

By Representative Dyer

On page 49 of the amendment, after line 37, insert the following:

ANEW SECTION. Sec. 401. WICKLINE CLAUSE STUDY. (1) There is some question regarding who should be liable when a health carrier or other third party-payer refuses to pay for or provide health services recommended by a health care provider and the patient suffers injury as a result of not receiving the recommended care. This issue typically arises in managed care systems, which integrate the financing and delivery of health care services to covered persons through selected providers. Contracts between health carriers and providers may address potential liability issues regarding the relationships between the carriers and the providers. Some contracts shift potential liability for a health carrier=s decision not to pay for recommended health services to the provider or patient through what are commonly referred to as AWickline clauses@. These clauses generally state it is a medical decision between the provider and patient as to whether the patient receives services that the carrier refuses to cover; this ignores the fact that the decision not to provide coverage influences the decision of the patient whether to receive the recommended care. The legislature intends to review the policy questions raised by this issue, particularly to what extent the carrier should be able to avoid liability for its decisions by insulating itself through its contracts with providers.

(2) A joint task force on Wickline clauses shall review the practice of contractually assigning or avoiding potential liability for decisions by health carriers or other third-party payers not to pay for health care services recommended by a health care provider.

The task force shall be comprised of two members of the house of representatives appointed by the speaker of the house, one from each major caucus, two members of the senate appointed by the president of the senate, one from each major caucus, and eight persons appointed by the legislative members of the task force. The eight non-legislative persons on the task force shall consist of: 2 representatives of health care providers; 2 representatives of health care consumers; 2 representatives of health carriers; and 2 representatives of self-funded health plans. The legislative members shall organize and administer the task force. Staffing shall be provided by the office of program research and senate committee services.

(3) The task force shall report to the health care committees of the legislature by December 1, 1997. The report shall discuss the policy issues regarding Wickline clauses and the more general issue of potential liability for decisions of health carriers and others not to cover health care recommended by the provider. The report may contain recommendations for the legislature to consider.@

Renumber remaining sections consecutively and correct internal references accordingly.

EFFECT: Creates a task force to review Wickline clauses and related issues. The task force is made up of 2 Senators, 2 Representatives, 2 representatives each of health care providers, consumers, health carriers, and self-funded health plans. A Wickline clause generally states that the health carrier is not liable for its decision not to cover a certain health care service; the provider generally assumes liability under these clauses as part of the provider-patient relationship. The task force makes a report and recommendations to the health care committees in the legislature by December 1, 1997.