Reasons Supporting Proposal: Requirements for the submission of provider agreements were originally placed in the Washington state system for electronic rate and form filing (SERFF) health and disability form filing general instructions. At that time, the health forms unit at OIC reviewed both health forms and provider agreements. Now the subject matter expertise for review of provider agreements is located in the provider network oversight program at OIC, and most carriers have a separate team for submission of these agreements, which have different filing requirements than health forms. Due to legislation passed in 2020 (2SSB 5601), carriers are also now required to file HCBM contracts, which include provider network management and other services that direct provider activity. The subject matter expertise for the review of HCBM contracting is located in the provider network oversight program that reviews provider agreements at OIC. Health carriers similarly have units that specialize in these types of agreement and contracting arrangements.

Explanation of exemptions: Requirements for the submission of provider agreements were originally placed in the Washington state SERFF health and disability form filing general instructions. At that time, the health forms unit at OIC reviewed both health forms and provider agreements. Now the subject matter expertise for review of provider agreements is located in the provider network oversight program at OIC, and most carriers have a separate team for submission of these agreements, which have different filing requirements than health forms. Due to legislation passed in 2020 (2SSB 5601), carriers are also now required to file HCBM contracts, which include provider network management and other services that direct provider activity. The subject matter expertise for the review of HCBM contracting is located in the provider network oversight program that reviews provider agreements at OIC. Health carriers similarly have units that specialize in these types of agreement and contracting arrangements. This rule will amend existing rules to establish unique general filing instructions for the submission of provider agreements and HCBM contracts by carriers.

Chapter 19.85 RCW states that "… an agency shall prepare a small business economic impact statement: (i) If the proposed rule will impose more than minor costs on businesses in an industry1…" The small business economic impact statement (SBEIS) must include "… a brief description of the reporting, recordkeeping, and other compliance requirements of the proposed rule, and the kinds of professional services that a small business is likely to need in order to comply with such requirements … To determine whether the proposed rule will have a disproportionate cost impact on small businesses2."

The definitions in this section apply throughout this chapter.

(1) "Complete filing" means a package of information containing forms, supporting information, documents and exhibits submitted to the commissioner electronically using the system for electronic rate and form filing (SERFF).

(2) "Date filed" means the date a complete filing has been received and accepted by the commissioner.

(3) "Filer" means:

(a) A person, organization or other entity that files forms or rates with the commissioner for an HCSC; or

(b) A person employed by the HCSC to file under this chapter.

(4) "Form" means a:

(a) "Contract" as defined in WAC 284-43-6020; and includes:

(i) Applications;

(ii) Certificates of coverage;

(iii) Disclosure forms;

(iv) Enrollment forms;

(v) Policy forms, including riders;

(vi) Termination notice forms;

(vii) Short form filing summary, as outlined in the SERFF filing instructions; and

(viii) All other forms that are part of the contract.

(b) "Contract form" as defined in WAC 284-43-6020;

(d) Participating provider agreements as required by RCW ((48.44.070))48.43.730 and WAC 284-170-480; and

(e) Medicare supplement forms required to be filed under chapter 48.66 RCW.

(5) "Health care benefit manager contract" or "HCBM contract" means a contract that includes the services under RCW 48.200.020(4) and any amendments made to such contracts.

(6) "Health care service contractor" or "HCSC" means the same as in RCW 48.44.010.

(((6)))(7) "NAIC" means the National Association of Insurance Commissioners.

(((7)))(8) "Objection letter" means correspondence created in SERFF and sent by the commissioner to the filer that:

(a) Requests clarification, documentation or other information;

(b) Explains errors or omissions in the filing; or

(((8)))(9) "Rate" or "rates" means all classification manuals, rate manuals, rating schedules, class rates, and rating rules that must be filed under RCW 48.44.040 or 48.66.035.

(((9)))(10) "Rate schedule" means the same as in WAC 284-43-6020.

(((10)))(11) "SERFF" means the system for electronic rate and form filing. SERFF is a proprietary NAIC computer-based application that allows insurers and other entities to create and submit rate, rule and form filings electronically to the commissioner.

(((11)))(12) "Type of insurance" or "TOI" means a specific type of health care coverage listed in the Uniform Life, Accident and Health, Annuity and Credit Coding Matrix published by the NAIC and available at www.naic.org.

SERFF is a dynamic application that the NAIC will revise and enhance over time. To be consistent with NAIC filing standards and provide timely instructions to filers, the commissioner will incorporate documents posted on the SERFF website into this chapter. By reference, the commissioner incorporates these documents into this chapter:

(1) The SERFF Industry Manual available within the SERFF application; and

(2) State specific rate and form filing instructions posted on the commissioner's website (www.insurance.wa.gov), including the:

(a) Washington State SERFF Life and Disability Form Filing General Instructions;

(b) Washington State SERFF Life, Health and Disability Rate Filing General Instructions;

(d) Washington State SERFF Health and Disability Binder Filing General Instructions (also called "plan management instructions"); and

(e) Washington State SERFF Carrier Provider Agreement and HCBM Contract Filing General Instructions.

(1) Each form or rate filing must be submitted to the commissioner electronically using SERFF.

(a) Every form filed in SERFF must:

(i) Be attached to the form schedule; and

(ii) Have a unique identifying number and a way to distinguish it from other versions of the same form.

(b) Filers must send all written correspondence related to a form or rate filing in SERFF.

(2) All filed forms must be legible for both the commissioner's review and retention as a public record. Filers must submit new or revised forms to the commissioner for review in final form displayed in ((ten-point))10-point or larger type.

(3) Filers must submit complete filings that comply with the SERFF Industry Manual available within the SERFF application and state specific instructions applicable to the particular filing, as revised from time to time and posted on the commissioner's website (www.insurance.wa.gov) including the:

(a) Washington State SERFF Life and Disability Form Filing General Instructions;

(b) Washington State SERFF Life, Health and Disability Rate Filing General Instructions;

(d) Washington State SERFF Health and Disability Binder Filing General Instructions (also called "plan management instructions"); and

(e) Washington State SERFF Carrier Provider Agreement and HCBM Contract Filing General Instructions.

(4) Filers must submit separate filings for each type of insurance.

The definitions in this section apply throughout this chapter.

(2) "Date filed" means the date a complete filing has been received and accepted by the commissioner.

(3) "Filer" means:

(a) A person, organization or other entity that files forms or rates with the commissioner for an HMO; or

(b) A person employed by the HMO to file under this chapter.

(4) "Form" means a:

(a) "Contract" as defined in WAC 284-43-6020; and includes:

(i) Applications;

(ii) Certificates of coverage;

(iii) Disclosure forms;

(iv) Enrollment forms;

(v) Policy forms, including riders;

(vi) Termination notice forms;

(vii) Short form filing summary, as outlined in the SERFF filing instructions; and

(viii) All other forms that are part of the contract.

(b) "Contract form" as defined in WAC 284-43-6020;

(d) Prepayment agreements described in RCW 48.46.060;

(e) Participating provider agreements as required by RCW ((48.46.243))48.43.730 and WAC 284-170-480; and

(f) Medicare supplement forms required to be filed under chapter 48.66 RCW.

(5) "Health care benefit manager contract" or "HCBM contract" means a contract that includes the services under RCW 48.200.020(4) and any amendments made to such contracts.

(6) "Health maintenance organization" or "HMO" means the same as in RCW 48.46.020.

(((6)))(7) "NAIC" means the National Association of Insurance Commissioners.

(((7)))(8) "Objection letter" means correspondence created in SERFF and sent by the commissioner to the filer that:

(a) Requests clarification, documentation or other information;

(b) Explains errors or omissions in the filing; or

(((8)))(9) "Rate" or "rates" means all classification manuals, rate manuals, rating schedules, class rates, and rating rules that must be filed under RCW 48.46.060 or 48.66.035.