WSR 98-22-108



[Insurance Commissioner Matter No. R 98-21--Filed November 4, 1998, 11:33 a.m.]

Subject of Possible Rule Making: The commissioner will amend rules governing health care provider contracts under the recently adopted chapter 284-43 WAC. These changes to provider contract rules will address problems brought to the attention of the commissioner by health care professionals and health care facilities. Subjects may include dispute resolution, provider payment, provider liability, plan medical management, and health information privacy.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.30.010, 48.43.055, 48.44.050, 48.44.070, 48.46.030, 48.46.200, and 48.46.243.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The terms and conditions of contracts between health carriers and health care providers affect the health care delivered to consumers and affect the coverage under the health plans sold to consumers. Many health care providers have complained of unfair terms and conditions contained in provider contracts. Providers have requested that the agency adopt additional standards for these contracts.

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

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

November 4, 1998

John S. Conniff

Deputy Commissioner

Managed Health Care