5927-S AMS KEIS NEED 940

SSB 5927 - S AMD 413

By Senator Keiser

WITHDRAWN 05/03/2011

    On page 6, line 13 after "system" strike "shall pay a nonparticipating provider that provides a service covered under this chapter to the system's enrollee no more than the amount paid for that service under the state's medicaid fee-for-service program." And insert, "shall only be obligated to pay the nonparticipating provider's charges based upon a statewide mode reimbursement rate for the same services contracted for under this section by the  managed health care system.  Any disputes over reimbursement shall be resolved pursuant to the managed health care system's dispute resolution process."

    On page 6, line 29 after "18.130.180(7)." Insert the following: "(9) Pursuant to federal managed care access standards, 42 CFR 438, managed health care systems must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the department, including hospital-based physician services."

    On page 10, line 7 after "system" strike "shall pay a nonparticipating provider that provides a service covered under this chapter to the system's enrollee no more than the amount paid for that service under the state's medicaid fee-for-service program." And insert, "shall only be obligated to pay the nonparticipating provider's charges based upon a statewide mode reimbursement rate for the same services contracted for under this section by the  managed health care system.  Any disputes over reimbursement shall be resolved pursuant to the managed health care system's dispute resolution process."

    On page 11, line 28 after "RCW 41.05.140." insert the following:

"(9) Pursuant to federal managed care access standards, 42 CFR 438, managed health care systems must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the department, including hospital-based physician services."

    On page 12, line 9 after "affected." Insert the following:

"NEW SECTION.  Sec. 7. This act expires on January 1, 2014."

EFFECT:

· Changes the requirement for Medicaid and Basic Health managed care plans to pay nonparticipating providers based on the statewide mode of the rates paid for the same services by the Medicaid or Basic Health managed health care system, rather than the Medicaid fee for service rate. Disputes shall be resolved using the managed care system's dispute resolution process.

· Requires the managed care contracts to maintain a network of appropriate providers, including hospital-based physician services

· Inserts an expiration date of 1/1/14.

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