| Passed by the Senate March 12, 2008 YEAS 46 BRAD OWEN ________________________________________ President of the Senate Passed by the House March 12, 2008 YEAS 81 FRANK CHOPP ________________________________________ Speaker of the House of Representatives | I, Thomas Hoemann, Secretary of the Senate of the State of Washington, do hereby certify that the attached is SECOND SUBSTITUTE SENATE BILL 5596 as passed by the Senate and the House of Representatives on the dates hereon set forth. THOMAS HOEMANN ________________________________________ Secretary | |
| Approved April 1, 2008, 3:30 p.m., with
the exception of section 3 which is
vetoed. CHRISTINE GREGOIRE ________________________________________ Governor of the State of Washington | April 2, 2008 Secretary of State State of Washington |
| State of Washington | 60th Legislature | 2008 Regular Session |
READ FIRST TIME 02/04/08.
AN ACT Relating to fair payment for chiropractic services; amending RCW 41.05.017; adding new sections to chapter 48.43 RCW; and providing an expiration date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 A new section is added to chapter 48.43 RCW
to read as follows:
(1)(a) A health carrier may not pay a chiropractor less for a
service or procedure identified under a particular physical medicine
and rehabilitation code or evaluation and management code, as listed in
a nationally recognized services and procedures code book such as the
American medical association current procedural terminology code book,
than it pays any other type of provider licensed under Title 18 RCW for
a service or procedure under the same code, except as provided in (b)
of this subsection. A carrier may not circumvent this requirement by
creating a chiropractor-specific code not listed in the nationally
recognized code book otherwise used by the carrier for provider
payment.
(b) This section does not affect a health carrier's:
(i) Implementation of a health care quality improvement program to
promote cost-effective and clinically efficacious health care services,
including but not limited to pay-for-performance payment methodologies
and other programs fairly applied to all health care providers licensed
under Title 18 RCW that are designed to promote evidence-based and
research-based practices;
(ii) Health care provider contracting to comply with the network
adequacy standards;
(iii) Authority to pay in-network providers differently than out-of-network providers; and
(iv) Authority to pay a chiropractor less than another provider for
procedures or services under the same code based upon geographic
differences in the cost of maintaining a practice.
(c) This section does not, and may not be construed to:
(i) Require the payment of provider billings that do not meet the
definition of a clean claim as set forth in rules adopted by the
commissioner;
(ii) Require any health plan to include coverage of any condition;
or
(iii) Expand the scope of practice for any health care provider.
(2) This section applies only to payments made on or after January
1, 2009.
Sec. 2 RCW 41.05.017 and 2007 c 502 s 2 are each amended to read
as follows:
Each health plan that provides medical insurance offered under this
chapter, including plans created by insuring entities, plans not
subject to the provisions of Title 48 RCW, and plans created under RCW
41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045,
48.43.505 through 48.43.535, 43.70.235, 48.43.545, 48.43.550,
70.02.110, 70.02.900, section 1 of this act, and 48.43.083.
*NEW SECTION. Sec. 3 A new section is added to chapter 48.43 RCW
to read as follows:
(1) On or after January 1, 2010, the commissioner shall contract
for an evaluation of the impact of section 1 of this act on the
utilization and cost of health care services associated with physical
medicine and rehabilitation payment or billing codes and evaluation and
management payment or billing codes, and on the total cost of episodes
of care for treatment associated with the use of these payment or
billing codes.
(2) The commissioner shall require carriers to provide to the
contractor such data as the contractor determines is necessary to
complete the evaluation under subsection (1) of this section. Data may
include, but need not be limited to, the following:
(a) Data on the utilization of physical medicine and rehabilitation
services and evaluation and management services associated with payment
or billing codes for those services;
(b) Data related to changes in the distribution or mix of health
care providers providing services under physical medicine and
rehabilitation payment or billing codes and evaluation and management
payment or billing codes;
(c) Data related to trends in carrier expenditures for services
associated with physical medicine and rehabilitation payment or billing
codes and evaluation and management payment or billing codes; and
(d) Data related to trends in carrier expenditures for the total
cost of health plan enrollee care for treatment of the presenting
health problems associated with the use of physical medicine and
rehabilitation payment or billing codes and evaluation and management
payment or billing codes.
(3) Data, information, and documents provided by the carrier
pursuant to this section are exempt from public inspection and copying
under chapter 42.56 RCW.
(4) The commissioner shall submit the evaluation required in
subsection (1) of this section to the appropriate committees of the
senate and house of representatives by January 1, 2012.
*Sec. 3 was vetoed. See message at end of chapter.
NEW SECTION. Sec. 4 This act expires June 30, 2013.