WSR 13-16-045 PERMANENT RULES OFFICE OF INSURANCE COMMISSIONER [Insurance Commissioner Matter No. R 2012-24—Filed July 31, 2013, 9:20 a.m., effective August 31, 2013] Effective Date of Rule: Thirty-one days after filing.
Purpose: This rule amends WAC 284-43-330 by removing language permitting provider agreements filed with the commissioner to omit proprietary compensation information. The rule also changes time-frames for the office of the insurance commissioner to disapprove a provider agreement from fifteen working days to thirty calendar days.
Citation of Existing Rules Affected by this Order: Amending WAC 284-43-330.
Statutory Authority for Adoption: RCW 48.02.060, 48.44.050, 48.46.030, 48.46.200, section 1, chapter 277, Laws of 2013.
Adopted under notice filed as WSR 13-12-081 on June 5, 2013.
A final cost-benefit analysis is available by contacting Donna Dorris, P.O. Box 40258, Olympia, WA 98504-0258, phone (360) 725-7040, fax (360) 586-3109, e-mail rulescoordinator@oic.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: July 29, 2013.
Mike Kreidler
Insurance Commissioner
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.
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