WSR 11-15-004



[ Filed July 6, 2011, 1:19 p.m. ]

Subject of Possible Rule Making: Chapter 246-305 WAC, Certification of independent review organizations.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 43.70.235 Health care disputes -- Certifying independent review organizations -- Application -- Restrictions -- Maximum fee schedule for conducting reviews -- Rules.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The 2010 Federal Patient Protection and Affordable Care Act (PPACA), Section 2719/Sec. 1001 Amendments to the Public Health Service Act, requires that health carriers comply with their state's independent review process if it includes the minimum consumer protections that are in the National Association of Insurance Commissioners (NAIC) Uniform External Review Model Act. The current process under chapter 246-305 WAC does not meet all of the new federal standards. The rules must be amended to meet the minimum federal requirements and continue to require that carriers use the state's process, which may benefit patients who request a review of a denied or reduced claim, and other minor housekeeping changes.

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 (HHS) and the Washington state office of the insurance commissioner. These agencies will receive notice of the rule making and be invited to participate in the stakeholder and rule-drafting processes.

Process for Developing New Rule: Collaborative rule making.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication contact Sherry Thomas, Program Manager, IRO Certification Program, Washington State Department of Health, P.O. Box 47850, Olympia, WA 98504-7850.

July 6, 2011

Mary C. Selecky


Washington State Code Reviser's Office