CERTIFICATION OF ENROLLMENT
ENGROSSED SUBSTITUTE SENATE BILL 6157
Chapter 193, Laws of 2018
65th Legislature
2018 Regular Session
HEALTH CARRIER PRIOR AUTHORIZATION--PROVIDER VISITS
EFFECTIVE DATE: June 7, 2018
ENGROSSED SUBSTITUTE SENATE BILL 6157
Passed Legislature - 2018 Regular Session
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State of Washington | 65th Legislature | 2018 Regular Session |
By Senate Health & Long Term Care (originally sponsored by Senators Short, Kuderer, Rivers, Cleveland, Palumbo, Nelson, Becker, Walsh, Warnick, and Van De Wege)
READ FIRST TIME 02/02/18.
AN ACT Relating to prior authorization; and amending RCW
48.43.016.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 48.43.016 and 2015 c 251 s 2 are each amended to read as follows:
(1) A health carrier that imposes different prior authorization standards and criteria for a covered service among tiers of contracting providers of the same licensed profession in the same health plan shall inform an enrollee which tier an individual provider or group of providers is in by posting the information on its web site in a manner accessible to both enrollees and providers.
(2) A health carrier may not require prior authorization for an
initial evaluation and management visit
((or an initial)) and up to six consecutive treatment visit
s with a contracting provider in a new episode of
care of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies
that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan. Notwithstanding RCW
48.43.515(5) this section may not be interpreted to limit the ability of a health plan to require a referral or prescription for the therapies listed in this section.
(3) A health carrier shall post on its web site and provide upon the request of a covered person or contracting provider any prior authorization standards, criteria, or information the carrier uses for medical necessity decisions.
(4) A health care provider with whom a health carrier consults regarding a decision to deny, limit, or terminate a person's covered health care services must hold a license, certification, or registration, in good standing and must be in the same or related health field as the health care provider being reviewed or of a specialty whose practice entails the same or similar covered health care service.
(5) A health carrier may not require a provider to provide a discount from usual and customary rates for health care services not covered under a health plan, policy, or other agreement, to which the provider is a party.
(6) For purposes of this section:
(a) "New episode of care" means treatment for a new or recurrent condition for which the enrollee has not been treated by the provider within the previous ninety days and is not currently undergoing any active treatment.
(b) "Contracting provider" does not include providers employed within an integrated delivery system operated by a carrier licensed under chapter
48.44 or
48.46 RCW.
Passed by the Senate February 12, 2018.
Passed by the House February 27, 2018.
Approved by the Governor March 22, 2018.
Filed in Office of Secretary of State March 26, 2018.
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