Washington State House of Representatives Office of Program Research	BILL ANALYSIS
Health Care

HB 1190

Brief Description:  Regarding medical billing.

Sponsors:  Representatives Schual‑Berke, Campbell, Romero and McMorris.

Brief Summary of Bill

$The Department of Social and Health Services may seek repayment of overpayments to vendors only if they can demonstrate intentional and knowing misconduct or clear disregard for understandable and specific billing rules.

Hearing Date:  2/2/01

Staff:  Dave Knutson (786‑7146).

Background: 

If the Department of Social and Health Services determines a vendor has been overpaid for providing service to a department client, the department seeks repayment of the overpayment.  The vendor is authorized to challenge the department=s determination using the administrative appeals process.

Summary of Bill: 

The Department of Social and Health Services is prohibited from denying payment for goods or services, imposing any liability for overpayments involving medical assistance services, or recouping payments to health care providers, unless the department shows through clear and convincing evidence intentional and knowing misconduct, or clear disregard for understandable  and specific billing rules.

Health care providers will be allowed to rebill the department and receive payment for any service denied payment, unless the department shows clear and convincing evidence of provider neglect.

All existing statutes related to vendor overpayments are waived, to the greatest extent possible.

Effective Date:  The bill contains an emergency clause and takes effect immediately.

Appropriation:  None.

Fiscal Note:  Requested on January 25, 2001.