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Resource Use (Cost/Utilization) Measurement and Reporting in Washington

        The availability of access and to financial and cost data is a key component of providing high quality, low cost care to patients.  To that end, Washington requires all hospital CEOs, and superintendents of state hospitals to create a process for disseminating to physicians and providers with admitting privileges the costs of the services they order, which can then be disclosed to patients.1  Hospitals are also required to submit financial data to the Department of Health.2  However, the Secretary or Director of the Department of Social and Health services may audit and investigate individuals and entities that provide medical services under this chapter.  In order to conduct the investigation or audit, the Secretary or Director must have access to any records necessary “to show accounts billed and received,” and to patient medical records in order to determine whether a provider furnished their billed services.  The Secretary or Director may not copy or disclose the names of patients contained in these records unless the patient is a public assistance beneficiary or applicant.3

        The Department of Health must determine whether participation in the uniform quality assurance program by all health plans, health care providers, and health care facilities within the state is possible through a study.4  The study design must include utilization measures, health plan fiscal performance standards, and other cost and financial data.5



  • 1. Wash. Rev. Code §70.41.250
  • 2. Wash. Rev. Code §43.70.052
  • 3. Wash. Rev. Code §74.09.290
  • 4. Wash. Rev. Code §43.70.066
  • 5. Wash. Rev. Code §43.70.066


Resource Use (Cost/Utilization) Measurement and Reporting in Washington

Subtopic Statute/Regulation Description
Financial information data collection Wash. Rev. Code § 43.70.066 Study--Uniform quality assurance and improvement program--Reports to legislature--Limitation on rule making The Department of Health (“...
Provider cost reporting Wash. Rev. Code § 48.43.125 If an individual with long-term care coverage is residing in a long-term care facility and is hospitalized, their insurer must cover their return to...
Access to health care cost information Wash. Rev. Code § 70.01.30 Estimate of Health Care Fees and Charges Upon a request by a patient, a provider must give the patient an estimate of fees and charges related to a...
Wash. Rev. Code § 70.41.250 Cost disclosure to health care providers All hospital CEOs and superintendents of state hospitals must create a process for disseminating to...
Required utilization/cost reporting Wash. Rev. Code § 70.47.060 Powers and duties of administrator — Schedule of services — Premiums, copayments, subsidies — Enrollment The Washington basic...