S-1050.1
SENATE BILL 5579
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State of Washington | 65th Legislature | 2017 Regular Session |
By Senators Rivers and Keiser
Read first time 01/30/17. Referred to Committee on Health Care.
AN ACT Relating to improving transparency and protecting patients from balance billing; adding new sections to chapter
70.43 RCW; and creating new sections.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. The legislature finds that a number of patients face surprise bills when a health care facility is in network, but certain providers, particularly those providing emergency services, radiology, pathology, laboratory, or anesthesiology services, may not be in network as they choose not to contract with health carriers. These noncontracted providers often balance bill patients for the difference between their billed charges and the carrier's payment. Patients are surprised by these bills and are not informed of the cost of services in advance of treatment. It is therefore the intent of the legislature to require hospitals that have contracts with health carriers to ensure that all providers who are treating patients at their facility have a contract not only to perform services, but also to establish reimbursement for such services and to not balance bill patients.
NEW SECTION. Sec. 2. A new section is added to chapter 70.43 RCW to read as follows:
(1) The governing body of any hospital licensed under chapter
70.41 RCW shall require that providers, including those licensed under chapter
18.71, 18.57, or
18.22 RCW, who are granted professional privileges which include admitting patients or delivering services and treatments at that hospital, must be an employee, part of its medical staff, or have a contract with the hospital to perform services in the hospital. The contract shall establish that reimbursement for services cannot be in excess of one hundred twenty-five percent of the medicare reimbursement rate for any covered person for which the hospital is in network or has a negotiated agreement with a health carrier.
(2) Providers who are performing services at the hospital which is contracted or in network with a health carrier must not balance bill a covered person as defined in RCW
48.43.005 and may not attempt to collect from a covered person any amount greater than the covered person's applicable cost-sharing based on the health benefit plan.
(3) As used in this section, "balance billing" means charging a covered person for health care services received by the covered person when the balance of the provider's fee is not fully reimbursed by the carrier, exclusive of permitted cost-sharing.
(4) This section applies to any privileges granted on or after January 1, 2018, and to all providers who have privileges in effect on or after January 1, 2018.
NEW SECTION. Sec. 3. A new section is added to chapter 70.43 RCW to read as follows:
(1) A hospital shall provide notice on its web site listing the names and hyperlinks for direct access to the web sites for each health carrier for which the facility contracts. The facility shall also list the provider groups that provide services to covered persons at the facility but are separate from the facility and are not employees or medical staff or do not have a contract with a health carrier.
(2) A hospital shall provide a written notice to the covered person within ten days of an appointment for services that are not an emergency medical condition or emergency services as defined in RCW
48.43.005. The notice provided must include the following:
(a) That the covered person may request that the facility provide an in-network or contracted health care provider for services and treatment;
(b) An estimated range of the cost of services with a disclaimer that the estimate does not account for the covered person's health benefit plan including cost-sharing requirements and the covered person may contact the health carrier for additional information regarding cost-sharing requirements; and
(c) As applicable, the names and contact information of all health care providers providing services to the covered person and whether each provider is contracted or participating in network with the covered person's health carrier.
NEW SECTION. Sec. 4. This act may be known and cited as the cost transparency and balance billing protection act.
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