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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

 

Footnotes

  • 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
Resource Use (Cost/Utilization) Measurement and Reporting Wash. Rev. Code § 43.20.285 Health impact reviews — Obtaining and allocating federal or private funding to implement chapter The state board of health, with the assistance...
Wash. Rev. Code § 43.70.066 Study--Uniform quality assurance and improvement program--Reports to legislature--Limitation on rule making The Department of Health (“...
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...
Wash. Rev. Code § 51.36.010 Findings — Minimum standards for providers — Health care provider network — Advisory group — Best practices treatment...
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...
Wash. Rev. Code § 74.09.290 Audits and investigations of providers — Patient records — Penalties The Secretary or Director of the department of social and health...