Transcript Highlights:

• reference to not being able to pass this tax along to consumers puts us potentially in conflict with RCW48

Bills: SB5845, SB5916, SB6102, SB6071, SB6103, SB6159, SB5877, SB5967, SB5904, SB5915, SB6025

Keywords: health insurance, health carrier, insurance carrier, prompt pay, timely payment, claims processing, clean claim, remittance advice, provider reimbursement, hospital billing, medical billing, prior authorization, claims denial, interest on late claims, administrative penalty, Washington insurance commissioner, RCW 48, public employees benefits board, school employees benefits board, Medicaid managed care

Summary: The committee heard public testimony on several health care bills. SB 6159 would create a public hospital infrastructure account funded by a new coverage assessment on insurers and other premium-tax payers, to help public hospital districts and other public health entities finance major construction and modernization projects and allow more cooperative agreements among public hospitals. The sponsor and supporters said it would help public hospitals remain competitive and better serve rural and underserved patients, while opponents argued the assessment would raise health care costs, could sweep in property and casualty insurers and mutual companies, and might create legal and affordability problems. Testimony also raised concerns that the bill’s cooperation language could unintentionally narrow existing affiliations with nonpublic entities. The hearing closed with 5 signed in pro, 74 con, and 2 other. The committee then heard SB 5845, which would replace the current 95% timely-payment standard with a requirement that all clean claims be paid or denied within 30 days, with notice requirements for incomplete claims and interest or penalties for late payment. Hospitals, physicians, and health systems strongly supported the bill, saying delayed and unpredictable payments create major cash-flow and administrative burdens and that some large claims can remain unpaid for months or longer even when care was approved. Health plans opposed the bill, saying they already meet current standards, that the bill could limit their ability to investigate fraud, waste, and abuse or review high-dollar claims, and that it should include more balanced timelines and exceptions. The hearing closed with 69 signed in pro, 4 con, and 2 other. The committee also heard SB 5916, which would prohibit health plans, Medicaid managed care organizations, and public employee plans from disadvantaging non-opioid pain treatments relative to opioids through formulary placement or utilization management, and would require a Department of Health educational pamphlet on non-opioid options. Patients, recovery advocates, and rare disease advocates supported the bill as a way to improve access to safer pain care and reduce barriers like prior authorization and step therapy. The Health Care Authority and an insurers’ representative said they support access to non-opioids but were concerned the bill could require preferred status for all non-opioids whenever any opioid is preferred, increasing costs and limiting formulary management. The hearing closed with 8 signed in pro, 1 con, and 2 other. Later, the committee heard SB 6102, a technical bill to align the ambulance transport quality assurance fee with federal rules after changes in federal law limited new provider taxes. The ambulance association supported the bill, saying the existing fee has significantly improved wages and benefits for EMS workers and that the change is needed to preserve the program. The hearing closed with 50 signed in pro, 1 con, and 0 other. The committee also heard SB 6103, which would make Medicaid payments for rural emergency hospitals subject to appropriation and create a state framework for a rural hospital conversion model. Supporters from East Adams Rural Health Care and the Washington State Hospital Association said the bill would help keep rural emergency services viable, especially for communities along the I-90 corridor. The hearing closed with 58 signed in pro, 1 con, and 0 other. Finally, the committee heard SB 6071, which would shorten the time limit for insurers to seek overpayment recoveries from providers from two years to six months, or nine months for coordination-of-benefits cases, extending a standard already enacted for mental health and substance use disorder services. Providers from acupuncture, massage, podiatry, and other small practices supported the bill, saying long clawback periods create financial instability and administrative burden, while the remaining testimony was still being taken when the transcript ended.