PREPROPOSAL STATEMENT OF INQUIRY
(Basic Health Plan)
Subject of Possible Rule Making: Revise WAC 182-25-020 to make benefits information more consistent with statute and to clarify the information applicants will receive prior to enrollment.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 70.47.050, 70.47.060.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Current rules need to be more flexile to accommodate statutory and budget limitations on basic health benefits. The current rules require "limited" mental health care, chemical dependency, and organ transplant services to be covered by basic health. However, RCW 70.47.060 makes these benefits dependent on available funding and requires that these services not be allowed to raise the actuarial value of the benefits package by more than 5%. The rules need to be revised to resolve that discrepancy.
In addition, rules regarding the benefits information that must be sent to applicants prior to enrollment also need to be more flexible. Input from applicant focus groups indicates that the current application materials are intimidating and too long. The revised rules will allow this information to be provided in summary form. Enrollees are sent the complete Schedule of Benefits after they have enrolled. The goal of the proposed revision is make the enrollment materials more helpful and "user friendly," while still providing applicants with the information they need to make an informed decision.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: No other federal or state agencies regulate this subject.
Process for Developing New Rule: Stakeholder mailings and public hearing.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Rosanne Reynolds (L3), Washington Basic Health Plan, P.O. Box 42683, Olympia, WA 98504-2683, phone (360) 923-2948, fax (360) 412-4267.
July 21, 1999
Elin Meyer
Rules Coordinator