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PPE Reimbursement

23 Apr 2021 5:02 PM | Amy Thomason (Administrator)


By Elizabeth Jane Brooks

Substitute Senate Bill 5169 -- PPE Reimbursement

SSB5169 enables all healthcare providers to seek reimbursement for personal protective equipment during the state of emergency related to COVID-19. This bill adds a new section to chapter 48.43 RCW and provides a contingent expiration date and declares an emergency.

The Washington State’s legislature finds that since the delivery of healthcare services is essential and maintaining patient safety during this pandemic is paramount, healthcare providers are incurring substantially increased costs in following state and federal regulations to minimize the risk of viral transmission. These costs are associated with obtaining personal protective equipment. Since these substantial costs have not been factored into our contracts with health carriers, the State Legislature found this bill necessary to alleviate the burden on healthcare providers. 

Many healthcare providers do not have a way to recoup the costs of personal protective equipment since many contracts with health carriers prevent the billing of supplies to patients and their health insurance providers. Therefore, the legislature finds that to help ensure patient safety and continued access to personal protective equipment, it is necessary that health carriers reimburse healthcare providers for costs associated with personal protective equipment.

A new section is added to chapter 48.43 RCW to read as follows: 

For the duration of the federal public health emergency related to COVID-19, a health benefit plan shall reimburse a health care provider who bills for incurred personal protective equipment expenses as a separate expense, using the American Medical Association's current procedural terminology code 99072 or as subsequently amended, $6.57 for each individual patient encounter. For purposes of this section, cost sharing is limited to the covered service according to the terms and conditions of the health benefit plan and does not apply to an expense for personal protective equipment. This section is not intended to apply to health care services that are not provided in person.

This act took effect on April 16, 2021 and will be in effect for the duration of the federal state of emergency related to COVID-19 and will expire when this state of emergency is over.

So, What Does This Mean?

Healthcare providers treating patients in state-regulated commercial health plans who have incurred costs for PPE will be able to bill the newly created CPT code 99072 and be reimbursed $6.57 per patient encounter as recommended by one of the American Medical Association's committee.

The law operates prospectively, meaning that carriers are not required to reimburse this code for dates of service prior to the law’s effective date; but moving forward and continuing for the duration of the federally declared state of emergency relating specifically to COVID-19, they must reimburse for it.

Given that it can be difficult to know whether a health plan is subject to state regulation, or is exempt from state laws, the Washington State Medical Association recommends billing the code liberally in appropriate circumstances as those health plans which are not subject to the law may opt to reimburse the code. 

In contrast, the Washington State Chiropractic Association (WSCA) recommends just billing state regulated plans (which do not include self-insured plans or those subject to ERISA) as this is a state law and ONLY applies to state regulated plans. They have produced a very helpful video Q&A that can be found here: https://www.youtube.com/watch?v=LTAwY3Pa4N0

You can read, (and you should read), the bill in its entirety here: http://lawfilesext.leg.wa.gov/biennium/2021-22/Pdf/Bills/Session%20Laws/Senate/5169-S.SL.pdf?q=20210423145331




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