WSCA sets its primary agenda based those bills with the greatest potential impact to chiropractic. These bills are detailed below.

History

In 2006 the WSCA introduced a bill that would have required insurance carriers to contract with health care providers who were employees of an already contracted provider. After more than 6 years of closed panel issues that limit patient access to care, and continuity of provider access to patients, the WSCA is proposing this measure to give patients better access to services that treat their covered conditions, and allowing providers to minimize additional costs endured when a patient has to be referred to a different clinic for services already offered in their own clinic. The WSCA has met with carriers regularly to seek other remedies with no resolution

(SB 5597 has a House Companion bill, HB 1630, but that bill will not be heard in committee due to time constraints. The House health committee chair has indicated that she will hear the Senate bills if we are successful getting them to pass the Senate.)

Sponsors In the House: Prime Sponsor Curtis, Morrell, Simpson, Cody, Campbell, Clibborn, McCune, Rodne, Green, Williams, McCoy, Priest, Dunn, Appleton, Chase, Dickerson, Ormsby, Conway

Sponsors In the Senate: Prime Sponsor Franklin, Benton, Zarelli, Kauffman, Kline, Carrell, Poulsen, Keiser, Kohl-Welles, Delvin, Roach

Provider Contracting: A carrier must contract with the employee providers of an already contracted chiropractor. This is not "any willing provider", and it won't address the inclusion of chiropractors blocked from entry to a closed panel if they are working on their own, it will allow already contracted providers to include those licensed providers that are employees, into the network. All employee providers must meet the credentialing standards, agree to the rules of the provider contract, and meet requirements related to quality and cost containment and the employee providers must not have sanctions on their license. We have made efforts to "meet the carriers in the middle" and this is our attempt at resolving a large part of the closed panel issues that face our members, and most importantly, their patients.

This also diminishes the fiscal challenge from the 2006 legislative session where the Health Care Authority, other insurers, and business, stated the costs would be a financial burden of great proportion. We are not yet aware of the details of a 2007 fiscal challenge.

This portion of the bill simply states that a carrier may not conflict with standards and practices authorized or adopted by the Washington State Chiropractic Quality Assurance Commission. A contractor may not prohibit a chiropractor from delegating duties in accordance with rules governing the chiropractic profession, through the WAC's, nor may they refuse to reimburse the contracted chiropractor for such delegated services if those services would be reimbursed if not delegated. This is necessary due to the lack of payment to a chiropractor when certain duties, within the law, are delegated to auxiliary staff. It is more costly to have doctors performing initial intake and medical history details which only increases the cost of the services. When a patient goes to a medical appointment a nurse regularly performs these functions, and the doctor, or clinic, is reimbursed for their services. Chiropractic services should be treated the same.

Notes 02/12/07: A hearing was held in the Senate with a great deal of opposition by business groups, organizations representing business, and insurers. Dr. David Butters and Dr. Austin McMillin provided expert testimony and were compelling in their arguments about why these bills are needed for patient care. (To see the video of the hearing go to www.TVW.org and go to the Senate Health and Long Term Care Committee hearing from 2/12/07 at 1:30pm.)

Notes 2/16/07: WSCA has drafted some amendments making the bill language less costly to the insurance companies without giving up language that protects patient access to chiropractic benefits.

Message to Legislators: Support SB 5597. This bill allows for continuity of care for services in the same clinic. Patients deserve access to providers who work in the same clinic.

(This bill has a House Companion bill, HB 1631, but that bill will not be heard in committee due to time constraints. The House health committee chair has indicated that she will hear the Senate bills if we are successful getting them to pass the Senate.)

Sponsors In the House: Prime Sponsor Curtis, Cody, Campbell, Morrell, Walsh, McCune, Rodne, Green, Williams, Simpson, McCoy, Dunn, Appleton, Chase, Ormsby, Conway, Moeller, Darneille

Sponsors In the Senate: Prime Sponsor Franklin, Benton, Kline, Poulsen, Keiser, Roach

This bill says that a carrier cannot pay a chiropractor using a differing formula than that of other professions, for the same service, using the same billing code. It is about time that the insurers pay for services based on the cost of the service, not what kind of provider is delivering it. If the provider has a license, and it is in their scope of practice, then it should be paid for the same.

GENERAL EFFECTS OF LEGISLATION (SB 5596/5597)

1. Nothing in either SB 5596 or SB 5597 limits a carrier's existing rights to terminate or refuse to renew a provider contract without cause.
2. Nothing in either SB 5596 or SB 5597 expands or mandates new benefits in health plans.
3. Carriers remain free to deny coverage for health care services that fail to meet standards for medical necessity and other traditional utilization review standards no matter who provides the care.
4. Carriers are prohibited in engaging in unfair practices with chiropractors already under contract with the carrier and with chiropractors who provide treatment consistent with professional standards of care.

Message to Legislators: Support SB 5596, it removes a carriers ability to arbitrarily pay providers for the same service without having a thoughtful methodology. Providers delivering the same services should receive the same fees which will help patients save money.

CHIROPRACTIC BUDGET REQUEST
Chiropractic Services funded for Medicaid patients

For several years adult patients with Medicaid benefits have not had any access to chiropractic services. The WSCA has initiated funding, even if at a minimal benefit, for underserved patients to have access to chiropractic care. This is a fiscal request and will be managed through the budgeting process.

The fiscal impact to the state budget process totals nearly $7 million for a 12 visit limit with no co-pay. A formal request for this item in the budget has been made by Rep. Tom Campbell, DC and I will update you as the budget process continues.

Message to Legislators: None at this time.

Sponsors: Parlette, Haugen, Pflug, Rockefeller, Carrell, Kastama, Rasmussen, Schoesler, Berkey, Hewitt, Brandland, Morton, Swecker, Stevens, Clements, Benton, Sheldon, Holmquist, Shin, Roach

This bill is the annual proposal by business to allow the insurance carriers to sell one plan that doesn’t have to honor mandated benefits, mandatory offerings (chiropractic is an offering), and the "every category of provider" law. The WSCA has regularly opposed this type of plan because it returns insurance companies to discriminating in a health plan and directing patient care to the medical community and disallowing patients a choice of what type of care, and provider, they choose.

Message to Legislators: Contact your Senator and ask them to oppose SB 5789. "It removes a chiropractor's right to compete in all health plans."

(This bill has a companion bill in the House, HB 1818).

Bill Digest: As consideration for being available to provide and providing all primary care services that are within the scope of the provider's license to a retainer subscriber during a specified service period if the retainer health care practice deposits the fee in one or more identifiable trust accounts and distributes the fee to the retainer practice at the end of the specified service period. Requires every retainer health care practice to maintain the following records for a period of five years, and upon request must make the following records available to the commissioner for review: (1) Forms of contracts between the retainer practice and retainer subscribers; (2) Documents relating to the creation and maintenance of any retainer fee trust accounts. However, any patient's personal identifying information may be withheld, unless otherwise authorized by the patient; (3) All advertising relating to the retainer practice and its services; and (4) All records relating to retainer fees received by the retainer health care practice. However, any patient's personal identifying information may be withheld, unless otherwise authorized by the patient. Directs the commissioner to adopt rules in accordance with chapter 34.05 RCW establishing a standardized disclosure form to be distributed to all retainer subscribers with their enrollment forms. Such form will inform the subscriber patient of their financial rights and responsibilities to the retainer practice as provided for in this act, will encourage that the retainer patient obtain and maintain insurance for services not provided by the retainer practice, and that the provider will not bill a carrier for services covered under the retainer agreement. Such a standardized disclosure form shall be deemed sufficient disclosure of a retainer practice's obligations under this act.

The WSCA would like some changes to the bill.

A hearing will be held on this bill on Monday, February 19, 2007.

Other bills will be added as soon as possible.