H-3282.1

SUBSTITUTE HOUSE BILL 2283

ByHouse Health Care & Wellness (originally sponsored by Representatives Rule, Leavitt, Reeves, and Valdez)

AN ACT Relating to establishing a medical loss ratio of at least 90 percent for health plans; and adding a new section 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) For health plans issued or renewed on or after January 1, 2028, the medical loss ratio shall be at least 90 percent.

(2) The commissioner may require carriers to submit, in the form and level of detail specified by the commissioner, information regarding a carrier's calculation of medical loss ratios as part of a carrier's health plan rate filings for plan years beginning on or after January 1, 2027. Such information may include, but is not limited to:

(a) A carrier's reimbursement, payments, or other remuneration to a carrier's owned or affiliated health care providers, health care facilities, health care benefit managers, or other entities;

(b) A carrier's use of nonclaims-based payments, such as subcapitation or bundled payment methodologies; and

(c) A carrier's payments for quality improvement, risk mitigation, and other incentive-based activities.

(3) The authority granted by this section does not modify or limit the commissioner's rate review authority under RCW 48.43.733, 48.44.017, and 48.46.062.

(4) The commissioner may adopt any rules necessary to implement this section.

(5) For the purposes of this section, "medical loss ratio" means the same as in 45 C.F.R. Sec. 158.221 (2025) as of January 1, 2026.

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