wa-law.org > bill > 2025-26 > HB 1812 > Original Bill
The legislature finds that anesthesia providers give individualized care to every patient, carefully assessing the patient's health prior to the surgery, looking at existing diseases and medical conditions to determine the resources and medical expertise needed, attending to the patient during the entire procedure, resolving unexpected complications that may arise and/or extend the duration of the surgery, and working to ensure that the patient is comfortable during recovery.
The legislature intends for this act to safeguard patient safety, uphold patient-centered care, and promote transparency and safety in anesthesia reimbursement practices by ensuring fair and ethical access to medically necessary anesthesia services. This act is critical to protecting patient safety and preventing the disturbing trend of commercial health insurers imposing time caps or physical status caps for anesthesia during surgery, leading to dangerous practices that could jeopardize lives. This year, insurers have targeted some of the most vulnerable patients receiving anesthesia care including those under the age of one, those over the age of 70, those in emergency conditions, and those with severe systemic diseases or illnesses.
Therefore, the legislature intends to address the alarming potential for insurance companies to impose arbitrary time limits or slash reimbursements based on the duration of care or patient physical status, prioritizing profit over patient well-being. By mandating consistent and dependable access to medically necessary anesthesia services, the legislature intends to provide safeguards to protect patient-centered care and allow health care providers to deliver safe, high quality care without undue interference or financial coercion.
Because the legislature finds that immediate action is necessary to protect the ability of health care providers to deliver medically necessary health care services to Washingtonians, this act is deemed necessary for the immediate preservation of the public health, welfare, peace, and safety.
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Health carriers for each health plan shall provide coverage for necessary anesthesia services for any procedure covered by the health plan, regardless of the duration of anesthesia care. Health carriers that provide coverage for anesthesia services may not deny coverage for anesthesia services or impose any cap on the reimbursement amount for anesthesia services on the basis that the duration of a procedure for which anesthesia services are performed exceeds a particular time limit.
Reimbursement for anesthesia services by health carriers must be determined based solely on necessity as assessed by the physician or certified registered nurse anesthetist. Health carriers are prohibited from:
Denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit;
Imposing arbitrary time-based limits or any other cap on reimbursement for anesthesia services provided during procedures requiring anesthesia care;
Imposing unilateral or arbitrary time limits on coverage or reimbursement for anesthesia services; and
Establishing, implementing, or enforcing any policy, practice, or procedure which restricts or excludes coverage or payment of anesthesia time or places a cap on such reimbursement.
For health plans issued on or after January 1, 2026, a health carrier may not make a distinction or implement policies or practices concerning verification of practice competency, coverage, billing codes, billing modifiers, compensation, or reimbursement if the physician or certified registered nurse anesthetist is acting within the scope of their practice pursuant to their licensure and certification, as both are equally authorized to independently deliver anesthesia care within their scope of practice.
All claims submitted for payment for anesthesia services must identify the national provider identifier of the physician or certified registered nurse anesthetist who provided the service.
A health carrier may not reduce the reimbursement amount paid to physicians or certified registered nurse anesthetists to comply with this subsection.
A health carrier may not discriminate against any health care provider providing anesthesia services who is located within the geographic coverage area of the health plan and who is willing to meet the terms and conditions for participation established by the health carrier as long as the terms and conditions are not more restrictive or burdensome than what is required under state law.
In addition to the commissioner's powers of enforcement authorized under RCW 48.02.080, the commissioner is authorized to take the following actions against health carriers that violate this section:
Impose civil monetary penalties as determined by the commissioner in rule;
Take additional corrective actions including, but not limited to, requiring health carriers to reimburse for improperly denied claims;
Suspend or revoke the health carrier's license to operate within the state of Washington for repeated or egregious violations; or
Require public disclosure of noncompliant health carriers, including publication of violations on the office of the insurance commissioner's website.
Individuals and health care providers affected by violations of this section may file a complaint with the office of the insurance commissioner or pursue other remedies as provided under state law.
Health carriers found in violation of the requirements in this section by the commissioner shall provide restitution to affected health care providers and enrollees, including compensatory payments for any financial losses incurred as a result of noncompliance as required by the commissioner.
The commissioner shall adopt rules to administer and implement this section.
Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 48.200.300 through 48.200.320, 48.43.440, section 2 of this act, and chapter 48.49 RCW.
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The authority and medicaid managed care organizations shall provide coverage for necessary anesthesia services for any procedure covered by the health plan, regardless of the duration of anesthesia care. The authority and medicaid managed care organizations that provide coverage for anesthesia services may not deny coverage for anesthesia services or impose any cap on the reimbursement amount for anesthesia services on the basis that the duration of a procedure for which anesthesia services are performed exceeds a particular time limit.
Reimbursement for anesthesia services by the authority and medicaid managed care organizations must be determined based solely on necessity as assessed by the physician or certified registered nurse anesthetist. The authority and medicaid managed care organizations are prohibited from:
Denying payment or reimbursement for anesthesia services solely because the duration of care exceeded a preset time limit;
Imposing arbitrary time-based limits or any other cap on reimbursement for anesthesia services provided during procedures requiring anesthesia care;
Imposing unilateral or arbitrary time limits on coverage or reimbursement for anesthesia services; and
Establishing, implementing, or enforcing any policy, practice, or procedure which restricts or excludes coverage or payment of anesthesia time or places a cap on such reimbursement.
Beginning January 1, 2026, the authority and medicaid managed care organizations may not make a distinction or implement policies or practices concerning verification of practice competency, coverage, billing codes, billing modifiers, compensation, or reimbursement if the physician or certified registered nurse anesthetist is acting within the scope of their practice pursuant to their licensure and certification, as both are equally authorized to independently deliver anesthesia care within their scope of practice.
All claims submitted for payment for anesthesia services must identify the national provider identifier of the physician or certified registered nurse anesthetist who provided the service.
The authority and medicaid managed care organizations may not reduce the reimbursement amount paid to physicians or certified registered nurse anesthetists to comply with this subsection.
The authority and medicaid managed care organizations may not discriminate against any health care provider providing anesthesia services who is located within the geographic coverage area of the health plan and who is willing to meet the terms and conditions for participation established by the authority or medicaid managed care organization as long as the terms and conditions are not more restrictive or burdensome than what is required under state or federal law.
This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately.