WSR 06-24-120

PROPOSED RULES

OFFICE OF THE

INSURANCE COMMISSIONER

[ Insurance Commissioner Matter No. R 2005-04 -- Filed December 6, 2006, 9:31 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 05-22-113.

Title of Rule and Other Identifying Information: Locum tenens provision (a person who is temporarily fulfilling the duties and responsibilities of another).

Hearing Location(s): General Administration, 1st Floor Auditorium, 11th and Columbia, Olympia, Washington 98504, on January 10, 2007, at 10:00.

Date of Intended Adoption: February 12, 2007.

Submit Written Comments to: Kacy Scott, P.O. Box 40255, Olympia, WA 98504-0258, e-mail Kacys@oic.wa.gov, fax (360) 586-3109, by January 8, 2007.

Assistance for Persons with Disabilities: Contact Lorie Villaflores by January 8, 2007, TTY (360) 586-0241 or (360) 725-7087.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These proposed rules would require health carriers to permit a contracted provider to select another provider who will serve as a substitute in the absence of the contracted provider for a period of not more than sixty days. The substitute provider is not required to be a member of the carrier's network.

Reasons Supporting Proposal: The Washington State Chiropractic Association petitioned the insurance commissioner for adoption of a rule to require carriers to include a "locum tenens" provision in contracts with chiropractors. After careful consideration the commissioner decided to include all provider types in proposed regulations. The resulting rule will affect all provider types who have a state license to "diagnose and treat human disease, ailment, or pain." This includes, but is not limited to, chiropractors.

Statutory Authority for Adoption: RCW 48.02.060 and 48.43.515.

Statute Being Implemented: RCW 48.43.515.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Mike Kreidler, insurance commissioner, governmental.

Name of Agency Personnel Responsible for Drafting: Melodie Bankers, P.O. Box 40258, (360) 725-7039; Implementation: Beth Berendt, P.O. Box 40255, (360) 725-7117; and Enforcement: Carol Sureau, P.O. Box 40255, (360) 725-7050.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The cost of compliance with this proposed rule for small businesses regulated by the office of the insurance commissioner would be minor or negligible.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kacy Scott, P.O. Box 40258, Olympia, WA 98504-0258, phone (360) 725-7041, fax (360) 586-3109, e-mail Kacys@oic.wa.gov.

December 6, 2006

Mike Kreidler

Insurance Commissioner

OTS-9368.2


NEW SECTION
WAC 284-43-260   Standards for temporary substitution of contracted network providers -- "Locum tenens" providers.   It is a longstanding and widespread practice for contracted network providers to retain substitute providers to take over their professional practices when the contracted network providers are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the contracted network provider to bill and receive payment for the substitute providers' services as though they were provided by the contracted network provider. The contracted network provider generally pays the substitute provider based on an agreement between the contracted network provider and the substitute provider, and the substitute provider has the status of an independent contractor rather than an employee of the contracted network provider. These substitute providers are commonly called "locum tenens" providers. The following are minimum standards for temporary provider substitution and do not prevent a carrier from entering into other agreed arrangements with its contracted network providers for terms that are less restrictive or more favorable to contracted network providers.

(1) Carriers must permit a contracted network provider to arrange for temporary substitution by a substitute provider. The substitute provider must be legally authorized to practice in this state and must have a current Washington license to diagnose and treat human disease, ailment, injury, or pain.

(2) Carriers must permit a period of substitution of at least sixty continuous days during any calendar year.

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Washington State Code Reviser's Office