SHB 2942 -
By Representative Curtis
ADOPTED AS AMENDED 02/13/2006
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 A new section is added to chapter 48.30 RCW
to read as follows:
(1) Whenever a health carrier's market share of persons covered by
all health plans within a local market meets or exceeds forty percent
as determined by the commissioner, the carrier may not directly, or
indirectly through a subcontracted network, terminate a provider
contract except for reasonable cause within that local market.
(2) Whenever a health carrier's market share of persons covered by
all health plans within a local market meets or exceeds forty percent
as determined by the commissioner, the carrier and any subcontracted
network of the carrier shall offer a provider contract to any provider
within the local market who meets the carrier's customary and
reasonable credentialing standards and agrees to comply with the terms
and conditions of the provider contract including provisions related to
quality assurance and utilization review.
(3) Beginning January 1, 2007, and every two years following, after
reasonable consideration of the information available from regularly
filed reports by carriers doing business in this state, the
commissioner shall publish a report identifying the carrier and the
local market within the state where the carrier's practices must
conform to the requirements of this section for the two years following
such identification. In making the determination, the commissioner
shall consider the carrier's local market share of persons covered
under all health plans providing direct or indirect reimbursement of
health care service.
(4) For the purposes of this section, "local market" means that
geographic area within the state where the particular carrier controls
forty percent or more of the market share of persons covered by all
health plans such as a particular county or a particular metropolitan
area as determined by the commissioner. In defining the local market,
the commissioner may consider the network reports filed with the
commissioner by carriers and standards used by the United States
department of justice antitrust division.
(5) For purposes of this section, "health plan" includes a health
plan as defined in RCW 48.43.005 and medical coverage programs
administered by the health care authority that are underwritten by a
health carrier.
(6) Nothing in this section may be deemed to require the
commissioner to rely upon any particular source of information in
making a finding required by this section.
(7) Nothing in this section shall diminish or impair any other
statutory provision prohibiting discrimination against any class of
providers.
(8) The provisions of this section do not apply to staff model
health maintenance organizations.
NEW SECTION. Sec. 2 A new section is added to chapter 48.30 RCW
to read as follows:
A carrier may impose a reasonable fee to the health care provider
to cover the cost of the credentialing and application of a licensed,
participating health care provider, and all fees must apply equally to
all health professions.
NEW SECTION. Sec. 3 The insurance commissioner may adopt rules
to implement this act."