WSR 11-14-113




[ Insurance Commissioner Matter No. R 2011-11 -- Filed July 6, 2011, 9:28 a.m. ]

Subject of Possible Rule Making: Grievance and appeal process requirements for health carriers and health plans.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The Affordable Care Act (ACA) became effective March 23, 2010. The ACA includes consumer protection elements, one of which requires carriers and plans to provide internal and external appeal processes. The proposed rule making will align chapter 284-43 WAC, with the federal requirements, creating consistent standards for carriers and plans.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The federal Department of Health and Human Services issued regulations implementing the ACA that will form the basis for the proposed rule making. The commissioner will continue to monitor federal guidance on appeal process requirements.

The Washington state department of health provides regulatory oversight of the independent review organizations (IRO) required for external appeals. The commissioner has met and reviewed the elements of the federal requirements with department of health. Coordination will continue through e-mail, telephone and in person meetings with the department of health.

Process for Developing New Rule: Notice and comment, submit written comments by August 31, 2011.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Meg L. Jones, P.O. Box 40258, Olympia, WA 98504, (360) 725-7170, fax (360) 725-7170, e-mail

July 6, 2011

Mike Kreidler

Insurance Commissioner

Washington State Code Reviser's Office