H-0314.1

HOUSE BILL 1160

ByRepresentatives Cody, Macri, and Pollet

AN ACT Relating to health provider contracts; and adding new sections to chapter 48.43 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1. A new section is added to chapter 48.43 RCW to read as follows:

(1) Beginning January 1, 2022, a contract between a hospital or any affiliate of a hospital and a health carrier shall not, directly or indirectly, do any of the following:

(a) Set provider compensation agreements or other terms for nonparticipating affiliates of the hospital;

(b) Require the health carrier to contract with any one or more of the hospital's affiliates.

(i) This section does not prohibit a contract from requiring that the health carrier contract with medical groups with which the hospital's medical staff is affiliated, or a health carrier from voluntarily agreeing to contract with other affiliates of the hospital.

(ii) If a health carrier voluntarily agrees to contract with other affiliates of the hospital under (b)(i) of this subsection, the health carrier must file an attestation with the office of the insurance commissioner within 30 days of the contract becoming effective or renewed;

(c) To the extent that a health plan varies enrollee cost-sharing based upon placing participating providers into provider tiers, require health insurers to place the hospital or any affiliate in the tier reflecting the lowest or lower enrollee cost-sharing amounts;

(d) Require the health carrier to keep the contract's payment rates confidential from any existing or potential payor that is or may become financially responsible for the payments. This subsection (1)(d) does not prohibit a requirement that any communication of the contract's payment rates to an existing or potential payor be subject to a reasonable nondisclosure agreement.

(2) For the purposes of this section:

(a) "Affiliate" means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person.

(b) "Control" means the possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of a person, whether through ownership of voting securities, membership rights, by contract, or otherwise.

(c) "Provider" means:

(i) A health care provider as defined in RCW  48.43.005;

(ii) A participating provider as defined in RCW  48.44.010;

(iii) A health care facility as defined in RCW  48.43.005; and

(iv) Intermediaries that have agreed in writing with a carrier to provide access to providers as defined under this subsection (2)(c) who render covered services to enrollees of a carrier.

(d) "Provider compensation agreement" means any written agreement that includes specific information about payment methodology, payment rates, and other terms that determine the remuneration a carrier will pay to a provider.

NEW SECTION.  Sec. 2. A new section is added to chapter 48.43 RCW to read as follows:

(1) Beginning January 1, 2022, health provider contracts between a health carrier and a provider, may not contain a provision that prohibits the disclosure of health care service claims data to employers providing the coverage. However, any disclosure of claims data must comply with state and federal health privacy laws.

(2) The legislature finds that the practices covered by this section are matters vitally affecting the public interest for the purpose of applying the consumer protection act, chapter  19.86 RCW. A violation of this section is not reasonable in relation to the development and preservation of business and is an unfair or deceptive act in trade or commerce and an unfair method of competition for the purpose of applying the consumer protection act, chapter  19.86 RCW.

(3) For the purposes of this section, "provider" means:

(a) A health care provider as defined in RCW  48.43.005;

(b) A participating provider as defined in RCW  48.44.010;

(c) A health care facility as defined in RCW  48.43.005; and

(d) Intermediaries that have agreed in writing with a carrier to provide access to providers as defined under this subsection who render covered services to enrollees of a carrier.

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