Anesthesia services

AN ACT Relating to patient-centered equitable access to 1
anesthesia services and reimbursement; reenacting and amending RCW 2
41.05.017; adding a new section to chapter 48.43 RCW; adding a new 3
section to chapter 74.09 RCW; creating a new section; and declaring 4
an emergency. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. The legislature finds that anesthesia 7
providers give individualized care to every patient, carefully 8
assessing the patient's health prior to the surgery, looking at 9
existing diseases and medical conditions to determine the resources 10
and medical expertise needed, attending to the patient during the 11
entire procedure, resolving unexpected complications that may arise 12
and/or extend the duration of the surgery, and working to ensure that 13
the patient is comfortable during recovery.14
The legislature intends for this act to safeguard patient safety, 15
uphold patient-centered care, and promote transparency and safety in 16
anesthesia reimbursement practices by ensuring fair and ethical 17
access to medically necessary anesthesia services. This act is 18
critical to protecting patient safety and preventing the disturbing 19
trend of commercial health insurers imposing time caps or physical 20
status caps for anesthesia during surgery, leading to dangerous 21
H-1082.2
HOUSE BILL 1812
State of Washington 69th Legislature 2025 Regular Session
By Representatives Rule, Caldier, Berg, Berry, Street, Shavers,
Parshley, Steele, Eslick, Pollet, and Hill
Read first time 02/04/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1812
practices that could jeopardize lives. This year, insurers have 1
targeted some of the most vulnerable patients receiving anesthesia 2
care including those under the age of one, those over the age of 70, 3
those in emergency conditions, and those with severe systemic 4
diseases or illnesses. 5
Therefore, the legislature intends to address the alarming 6
potential for insurance companies to impose arbitrary time limits or 7
slash reimbursements based on the duration of care or patient 8
physical status, prioritizing profit over patient well-being. By 9
mandating consistent and dependable access to medically necessary 10
anesthesia services, the legislature intends to provide safeguards to 11
protect patient-centered care and allow health care providers to 12
deliver safe, high quality care without undue interference or 13
financial coercion. 14
Because the legislature finds that immediate action is necessary 15
to protect the ability of health care providers to deliver medically 16
necessary health care services to Washingtonians, this act is deemed 17
necessary for the immediate preservation of the public health, 18
welfare, peace, and safety. 19
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 20
RCW to read as follows: 21
(1)(a) Health carriers for each health plan shall provide 22
coverage for necessary anesthesia services for any procedure covered 23
by the health plan, regardless of the duration of anesthesia care. 24
Health carriers that provide coverage for anesthesia services may not 25
deny coverage for anesthesia services or impose any cap on the 26
reimbursement amount for anesthesia services on the basis that the 27
duration of a procedure for which anesthesia services are performed 28
exceeds a particular time limit. 29
(b) Reimbursement for anesthesia services by health carriers must 30
be determined based solely on necessity as assessed by the physician 31
or certified registered nurse anesthetist. Health carriers are 32
prohibited from: 33
(i) Denying payment or reimbursement for anesthesia services 34
solely because the duration of care exceeded a preset time limit;35
(ii) Imposing arbitrary time-based limits or any other cap on 36
reimbursement for anesthesia services provided during procedures 37
requiring anesthesia care; 38
p. 2 HB 1812
(iii) Imposing unilateral or arbitrary time limits on coverage or 1
reimbursement for anesthesia services; and 2
(iv) Establishing, implementing, or enforcing any policy, 3
practice, or procedure which restricts or excludes coverage or 4
payment of anesthesia time or places a cap on such reimbursement.5
(2) For health plans issued on or after January 1, 2026, a health 6
carrier may not make a distinction or implement policies or practices 7
concerning verification of practice competency, coverage, billing 8
codes, billing modifiers, compensation, or reimbursement if the 9
physician or certified registered nurse anesthetist is acting within 10
the scope of their practice pursuant to their licensure and 11
certification, as both are equally authorized to independently 12
deliver anesthesia care within their scope of practice.13
(a) All claims submitted for payment for anesthesia services must 14
identify the national provider identifier of the physician or 15
certified registered nurse anesthetist who provided the service.16
(b) A health carrier may not reduce the reimbursement amount paid 17
to physicians or certified registered nurse anesthetists to comply 18
with this subsection. 19
(c) A health carrier may not discriminate against any health care 20
provider providing anesthesia services who is located within the 21
geographic coverage area of the health plan and who is willing to 22
meet the terms and conditions for participation established by the 23
health carrier as long as the terms and conditions are not more 24
restrictive or burdensome than what is required under state law.25
(3) In addition to the commissioner's powers of enforcement 26
authorized under RCW 48.02.080, the commissioner is authorized to 27
take the following actions against health carriers that violate this 28
section: 29
(a) Impose civil monetary penalties as determined by the 30
commissioner in rule; 31
(b) Take additional corrective actions including, but not limited 32
to, requiring health carriers to reimburse for improperly denied 33
claims; 34
(c) Suspend or revoke the health carrier's license to operate 35
within the state of Washington for repeated or egregious violations; 36
or 37
(d) Require public disclosure of noncompliant health carriers, 38
including publication of violations on the office of the insurance 39
commissioner's website. 40
p. 3 HB 1812
(4) Individuals and health care providers affected by violations 1
of this section may file a complaint with the office of the insurance 2
commissioner or pursue other remedies as provided under state law.3
(5) Health carriers found in violation of the requirements in 4
this section by the commissioner shall provide restitution to 5
affected health care providers and enrollees, including compensatory 6
payments for any financial losses incurred as a result of 7
noncompliance as required by the commissioner. 8
(6) The commissioner shall adopt rules to administer and 9
implement this section. 10
Sec. 3. RCW 41.05.017 and 2024 c 251 s 5 and 2024 c 242 s 10 are 11
each reenacted and amended to read as follows: 12
Each health plan that provides medical insurance offered under 13
this chapter, including plans created by insuring entities, plans not 14
subject to the provisions of Title 48 RCW, and plans created under 15
RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 16
70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 17
48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 18
48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 19
48.200.300 through 48.200.320, 48.43.440, section 2 of this act, and 20
chapter 48.49 RCW. 21
NEW SECTION. Sec. 4. A new section is added to chapter 74.09 22
RCW to read as follows: 23
(1)(a) The authority and medicaid managed care organizations 24
shall provide coverage for necessary anesthesia services for any 25
procedure covered by the health plan, regardless of the duration of 26
anesthesia care. The authority and medicaid managed care 27
organizations that provide coverage for anesthesia services may not 28
deny coverage for anesthesia services or impose any cap on the 29
reimbursement amount for anesthesia services on the basis that the 30
duration of a procedure for which anesthesia services are performed 31
exceeds a particular time limit. 32
(b) Reimbursement for anesthesia services by the authority and 33
medicaid managed care organizations must be determined based solely 34
on necessity as assessed by the physician or certified registered 35
nurse anesthetist. The authority and medicaid managed care 36
organizations are prohibited from: 37
p. 4 HB 1812
(i) Denying payment or reimbursement for anesthesia services 1
solely because the duration of care exceeded a preset time limit;2
(ii) Imposing arbitrary time-based limits or any other cap on 3
reimbursement for anesthesia services provided during procedures 4
requiring anesthesia care; 5
(iii) Imposing unilateral or arbitrary time limits on coverage or 6
reimbursement for anesthesia services; and 7
(iv) Establishing, implementing, or enforcing any policy, 8
practice, or procedure which restricts or excludes coverage or 9
payment of anesthesia time or places a cap on such reimbursement.10
(2) Beginning January 1, 2026, the authority and medicaid managed 11
care organizations may not make a distinction or implement policies 12
or practices concerning verification of practice competency, 13
coverage, billing codes, billing modifiers, compensation, or 14
reimbursement if the physician or certified registered nurse 15
anesthetist is acting within the scope of their practice pursuant to 16
their licensure and certification, as both are equally authorized to 17
independently deliver anesthesia care within their scope of practice.18
(a) All claims submitted for payment for anesthesia services must 19
identify the national provider identifier of the physician or 20
certified registered nurse anesthetist who provided the service.21
(b) The authority and medicaid managed care organizations may not 22
reduce the reimbursement amount paid to physicians or certified 23
registered nurse anesthetists to comply with this subsection.24
(c) The authority and medicaid managed care organizations may not 25
discriminate against any health care provider providing anesthesia 26
services who is located within the geographic coverage area of the 27
health plan and who is willing to meet the terms and conditions for 28
participation established by the authority or medicaid managed care 29
organization as long as the terms and conditions are not more 30
restrictive or burdensome than what is required under state or 31
federal law. 32
NEW SECTION. Sec. 5. This act is necessary for the immediate 33
preservation of the public peace, health, or safety, or support of 34
the state government and its existing public institutions, and takes 35
effect immediately.36
--- END ---
p. 5 HB 1812