Official Text and Analysis.

Establishes the balance billing protection act. Addresses the charges for out-of-network health services.

Clarifies that an out-of-network provider or facility may not balance bill a covered person for the specified health care services. Modifies the nonemergency services for which balance billing is prohibited by removing reference to invasive medical procedures and removing services by an out-of-network provider without the covered person's consent. (2) Applies cost-sharing and dispute resolution provisions to health care facilities, in addition to health care providers. Requires carriers to calculate the in-network cost-sharing rate using the carrier's median (rather than average) contracted rate. Requires carriers to make payments directly to providers and facilities. (3) Requires carriers to pay a billed amount of less than $300. Permits, when the billed amount is $300 or more, a carrier and out- of-network provider or facility to use mediation or, if the amount in dispute is $2000 or more, arbitration. Requires mediation expenses to be divided equally among the carrier, provider, and facility, if the amount in dispute is less than $2000.

Striker amendment. Modifies requirements related to coverage of emergency services provided at an out-of-network emergency department. ? Regulates the practice of balance billing by out-of-network providers and facilities, and authorizes arbitration and mediation of balance billing disputes. ? Requires health care facilities, providers, and carriers to provide patients with information about network status. ? Requires carriers to treat hospitals and ambulatory surgical facilities as out-of- network if a certain percentage of providers who provide surgical or ancillary services do not contract with the same carrier.

Requires the Washington State Institute for Public Policy to study and make recommendations regarding balance billing laws in other states. Removes provisions regarding: (a) banning balance billing for certain services, (b) establishing a payment methodology for out-of-network services, (c) establishing a dispute resolution process, (d) disclosures to patients regarding balance billing, (e) transparency regarding the network status of providers, and (f) enforcement.