2942-SAMHCURTH5164.1SHB 2942H AMD819By Representative CurtisADOPTED AS AMENDED 02/13/2006 Strike everything after the enacting clause and insert thefollowing:NEW SECTION.Sec. A new section is added to chapter 48.30 RCWto read as follows: (1) Whenever a health carrier's market share of persons covered byall health plans within a local market meets or exceeds forty percentas determined by the commissioner, the carrier may not directly, orindirectly through a subcontracted network, terminate a providercontract except for reasonable cause within that local market. (2) Whenever a health carrier's market share of persons covered byall health plans within a local market meets or exceeds forty percentas determined by the commissioner, the carrier and any subcontractednetwork of the carrier shall offer a provider contract to any providerwithin the local market who meets the carrier's customary andreasonable credentialing standards and agrees to comply with the termsand conditions of the provider contract including provisions related toquality assurance and utilization review. (3) Beginning January 1, 2007, and every two years following, afterreasonable consideration of the information available from regularlyfiled reports by carriers doing business in this state, thecommissioner shall publish a report identifying the carrier and thelocal market within the state where the carrier's practices mustconform to the requirements of this section for the two years followingsuch identification. In making the determination, the commissionershall consider the carrier's local market share of persons coveredunder all health plans providing direct or indirect reimbursement ofhealth care service. (4) For the purposes of this section, "local market" means thatgeographic area within the state where the particular carrier controlsforty percent or more of the market share of persons covered by all Official Print - 1 health plans such as a particular county or a particular metropolitanarea as determined by the commissioner. In defining the local market,the commissioner may consider the network reports filed with thecommissioner by carriers and standards used by the United Statesdepartment of justice antitrust division. (5) For purposes of this section, "health plan" includes a healthplan as defined in RCW 48.43.005 and medical coverage programsadministered by the health care authority that are underwritten by ahealth carrier. (6) Nothing in this section may be deemed to require thecommissioner to rely upon any particular source of information inmaking a finding required by this section. (7) Nothing in this section shall diminish or impair any otherstatutory provision prohibiting discrimination against any class ofproviders. (8) The provisions of this section do not apply to staff modelhealth maintenance organizations.NEW SECTION.Sec. A new section is added to chapter 48.30 RCWto read as follows: A carrier may impose a reasonable fee to the health care providerto cover the cost of the credentialing and application of a licensed,participating health care provider, and all fees must apply equally toall health professions.NEW SECTION.Sec. The insurance commissioner may adopt rulesto implement this act.--- END --- Official Print - 2