(1) A health carrier
must reimburse a chiropractor who has signed a participating
provider agreement for services determined by the carrier to be
medically necessary if:
(a) The service is:
(i) Covered chiropractic health care, as defined in RCW 48.43.515, by the health plan under which the enrollee received
the services; and
(ii) Provided by the chiropractor, or the chiropractor's
employee specified in RCW 18.25.190 (2) or (3) who works in the
same location as the chiropractor and to whom the chiropractor,
pursuant to rules adopted by the Washington state chiropractic
quality assurance commission, has delegated the service. The
employee must meet the health carrier's reasonable qualifications
for all such providers in the relevant class, including but not
limited to standards for education and background checks, as
applicable; and
(b) The chiropractor complies with the terms and conditions
of the participating provider agreement. Violations of the
participating provider agreement by an employee of the
chiropractor to whom he or she has delegated a service may be
deemed by the carrier to have been committed by the chiropractor.
(2) If a health carrier offers a participating provider
agreement to a chiropractor within a single practice organized as
a sole proprietorship, partnership, or corporation, the carrier
must offer the same participating provider agreement to any other
chiropractor within that practice providing services at the same
location. The agreement may allow either party to terminate it
without cause.
[2007 c 502 § 1.]
NOTES:
Savings -- 2007 c 502: "This act does not affect any existing right acquired or liability or obligation incurred prior to January 1, 2008." [2007 c 502 § 3.]
Severability -- 2007 c 502: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [2007 c 502 § 4.]
Effective date -- 2007 c 502: "This act takes effect January 1, 2008." [2007 c 502 § 5.]