WSR 13-12-081

PROPOSED RULES

OFFICE OF

INSURANCE COMMISSIONER

[ Insurance Commissioner Matter No. R 2012-24 -- Filed June 5, 2013, 11:40 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 12-19-082.

Title of Rule and Other Identifying Information: Participating provider contracts.

Hearing Location(s): Training Room, T-120, 5000 Capitol Way South, Tumwater, WA, on July 11, 2013, at 10:00 a.m.

Date of Intended Adoption: July 15, 2013.

Submit Written Comments to: Donna Dorris, P.O. Box 40258, Olympia, WA 98504, e-mail rulescoordinator@oic.wa.gov, fax (360) 586-3109, by July 11, 2013.

Assistance for Persons with Disabilities: Contact Lori [Lorie] Villaflores by July 10, 2013, TTY (360) 586-0241 or (360) 725-7087.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule amends WAC 284-43-330 by removing language permitting provider agreements filed with the commissioner to omit proprietary compensation information. The rule changes timeframes for the office of insurance commissioner (OIC) to disapprove a provider agreement from fifteen working days to thirty calendar days.

Reasons Supporting Proposal: This proposed rule will be consistent with underlying statutory requirements.

The Affordable Care Act (ACA) requires the OIC to determine if reimbursement methods incentivize health homes, chronic care management, or care coordination for enrollees with complex, high-cost, or multiple chronic conditions, as a component of certification as a qualified health plan (QHP) eligible to participate in the exchange. In order to conduct this analysis the OIC needs access to the proprietary compensation information.

Legislation, SSB 5434, consistent with this rule making passed during the 2013 regular session. The governor signed the bill on May 16, 2013, and chapter 277, Laws of 2013, is effective on July 28, 2013.

Statutory Authority for Adoption: RCW 48.02.060, 48.44.050, 48.44.070, 48.46.030, 48.46.200.

Statute Being Implemented: RCW 48.44.070, 48.46.030, 48.46.243.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Mike Kreidler, insurance commissioner, governmental.

Name of Agency Personnel Responsible for Drafting: Donna Dorris, P.O. Box 40258, Olympia, WA 98504-0258, (360) 725-7040; Implementation: Beth Berendt, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7117; and Enforcement: Chuck Brown, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7044.

No small business economic impact statement has been prepared under chapter 19.85 RCW. None of the health carriers affected are small businesses under the provisions of RCW 19.85.020(3).

A cost-benefit analysis is not required under RCW 34.05.328. These proposed rule changes are the minimum necessary to meet the explicit, specific content of recently passed legislation (SSB 5434). Therefore, a cost-benefit analysis for this rule amendment is not needed under the provisions of RCW 34.05.328 (5)(b)(v).

June 5, 2013

Mike Kreidler

Insurance Commissioner

OTS-5003.2


AMENDATORY SECTION(Amending Matter No. R 98-21, filed 10/11/99, effective 11/11/99)

WAC 284-43-330   Participating provider -- Filing and approval.   (1) ((Beginning May 1, 1998,)) A health carrier ((shall)) must file with the commissioner ((fifteen working)) thirty calendar days prior to use sample contract forms proposed for use with its participating providers and facilities. ((A health carrier need not submit contract provisions governing payment rates, amounts, or similar proprietary information that would indicate provider or facility compensation.))

(2) A health carrier shall submit material changes to a sample contract form to the commissioner ((fifteen working)) thirty calendar days prior to use. Carriers shall indicate in the filing whether any change affects a provision required by this chapter. All changes to contracts must be indicated through strike outs for deletions and underlines for new material. Alternatively, carriers may refile a sample contract that incorporates changes along with a copy of the contract addendum or amendment and any correspondence that will be sent to providers and facilities sufficient for a clear determination of contract changes. Changes not affecting a provision required by this chapter are deemed approved upon filing.

(3) If the commissioner takes no action within ((fifteen working)) thirty calendar days after submission of a sample contract or a material change to a sample contract form by a health carrier, the change or form is deemed approved except that the commissioner may extend the approval period an additional fifteen ((working)) calendar days upon giving notice before the expiration of the initial ((fifteen-day)) thirty-day period. Approval may be subsequently withdrawn for cause.

(4) The health carrier shall maintain provider and facility contracts at its principal place of business in the state, or the health carrier shall have access to all contracts and provide copies to facilitate regulatory review upon twenty days prior written notice from the commissioner.

[Statutory Authority: 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. 99-21-016 (Matter No. R 98-21), 284-43-330, filed 10/11/99, effective 11/11/99. Statutory Authority: RCW 48.02.060, 48.20.450, 48.20.460, 48.30.010, 48.44.020, 48.44.050, 48.44.080, 48.46.030, 48.46.060(2), 48.46.200 and 48.46.243. 98-04-005 (Matter No. R 97-3), 284-43-330, filed 1/22/98, effective 2/22/98.]