WSR 98-22-041



[Insurance Commissioner Matter No. R 98-20--Filed October 29, 1998, 4:56 p.m.]

Subject of Possible Rule Making: The commissioner will consider new rules implementing the health care provider provisions of RCW 48.43.045, commonly referred to as the "every category of provider" statute. The new rules will supersede an earlier declaratory order (G 96-13) filed on May 21, 1996.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.18.120, 48.20.450, 48.20.460, 48.30.010, 48.44.050, and 48.46.200.

Statute Being Implemented: RCW 48.43.045.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The agency issued a declaratory order in 1996 to clarify issues relating to health carrier compliance with the "every category of provider" statute. Since the 1996 order, carrier and health care provider experiences and the need for guidance in complying with the statute suggest that a rule would resolve issues raised by carriers, consumers, and health care providers. Among the issues addressed in the order and likely to be included in new rules are the following: Application of the statute to particular health plans and services; credentialing of health care providers; limits on coverage or health services; and the use of separately priced, optional riders to comply with the law.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.

Process for Developing New Rule: Agency study; and the commissioner will form small groups comprised of affected parties to consider developing new rules.

Deadline for Comments: November 30, 1998.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Kacy Brandeberry, P.O. Box 40256, Olympia, WA 98504-0256, phone (360) 407-0729, fax (360) 407-0186, internet

October 28, 1998

John S. Conniff

Deputy Commissioner

Managed Health Care