2023-02 Revising the prior authorization process (with addition of new substance use disorder treatment requirements)

The legislature has modernized prior authorization processes to prevent delays in care and improve health outcomes. To implement these objectives, OIC will resume its work on prior authorization revisions from last year's E2SHB 1357 and will include the corresponding mental health-related utilization management requirements from this year's 2SSB 6228. This rule-making package will recommence at the CR-101 phase.

Joyce Brake

Delika Steele

Jane Beyer

Relating to health care benefit managers

E2SSB 5213 promotes greater prescription drug transparency and more consumer choice on how to obtain prescriptions. The bill prohibits pharmacy benefit managers (PBMs) from spread pricing and sets limits on consumer cost sharing within PBM transactions. This rule making will implement the new regulations governing PBMs.

Nico Janssen

Jane Beyer

Protecting consumers from out-of-network health care charges and increasing the cap on Balance Billing Protection Act (BBPA) arbitration fees

SSB 5986 bans balance billing for covered emergency and nonemergency ground ambulance transportation. This rule making will revise current rules to include ground ambulance service providers and will increase the cap on BBPA arbitration fees.

Sydney Rogalla

Jane Beyer

Consolidated health care rule making

This rule making will consolidate efforts in several areas:

• SB 5300: Concerning continuity of coverage for prescription drugs prescribed for the treatment of behavioral health conditions

• HB 2041: Concerning physician assistant collaborative practice

• SB 5821: Establishing a uniform standard for creating an established relationship for the purposes of audio-only telemedicine services

• ESHB 1957: Preserving coverage of preventive services without cost-sharing

• Carrier Overpayment Recovery Limits: Limiting the number of times a carrier may request a refund within 24- or 30-month time frames and defining "date that the payment was made" to limit the recurrence of refund and claims reprocessing requests

Delika Steele

Jane Beyer

Concerning the insurer holding company act

SB 6027 aligns Washington's insurer holding company system with the National Association of Insurance Commissioners' standards. The rule revisions will focus on group solvency supervision and liquidity stress test standards.

Andrew Davis

David Forte

Clarifying limited line credit inclusion and Designated Responsible Licensed Producer (DRLP) additions during agency renewal process

Clarifies that when a producer holds any line of authority (life, disability, property, or casualty) or combination of lines of authority, limited line credit is included in those lines. Allows insurance agencies to add/affiliate new DRLPs during the renewal process when current DRLP license is inactive.

Andrew Davis

David Forte

Technical-clean-up: Removing the adjuster continuing education exemption, the producer prelicensing education (PLE) requirement, and past licensing electronic submission dates

This technical clean-up will ensure that insurance rules are clear, relevant, and align with Title 48. This rule making will clarify adjuster continuing education requirements and producer PLE course requirements. It will also remove past dates associated with licensing electronic submissions.

Simon Casson

*Prescribing the duties of title insurance escrow agents

Prescribes the duties of title insurance agents acting as escrow agents to match those of the Title Insurers Model Act.

*Requiring disclosures for life insurance policy surrenders

This rule making will ensure that consumers receive proper disclosure on the effects of life insurance policy surrenders.