WSR 97-16-048

PREPROPOSAL STATEMENT OF INQUIRY

INSURANCE COMMISSIONER'S OFFICE

[Insurance Commissioner Matter No. R 97-3--Filed July 31, 1997, 3:28 p.m.]

Subject of Possible Rule Making: The commissioner will amend, create, consolidate, and repeal rules governing managed care plans offered by insurers, health care service contractors, and health maintenance organizations through the creation of a new chapter in Title 284 WAC that will eventually contain all rules governing managed care. The commissioner will begin by creating new subchapters relating to data reporting and consumer disclosures; reporting requirements for network adequacy; provider contracts; grievance procedures; and dispute resolution standards. The commissioner will coordinate rule making with other state agencies and will consider private accreditation standards and state agency health care purchasing standards including the contracting requirements of the Health Care Authority and the Medicaid program.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.18.120, 48.20.450, 48.20.460, 48.30.010, 48.44.050, 48.46.030, and 48.46.200.

Statues Being Implemented: RCW 48.18.110, 48.43.055, 48.44.020, 48.44.070, 48.44.080, 48.46.040, 48.46.060, and 48.46.243.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Current rules governing health care carriers offering managed health care plans need revision, consolidation, repeal, and development to create a consistent regulatory environment for managed health care. Some provisions of Title 284 WAC have been superseded by recent health care reform statutes. Some provisions of Title 284 WAC are inconsistent with other provisions of the title. Some rules are incomplete or no longer address the most pressing managed care issues. A new chapter of rules containing all standards for managed care plans will repeal older rules inconsistent with current insurance statutes, will better meet the needs of consumers for access to quality health care services promised under managed care plans, will foster consistent standards between the insurance commissioner and other state agencies, and will simplify regulatory oversight and carrier compliance with insurance laws.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The commissioner will consult with other state agencies involved in the development, purchase, and provision of managed health care services to minimize conflict between insurance regulations and other state agency rules on the same or similar subjects.

Process for Developing New Rule: For questions regarding substance of these rules, contact John Conniff, (360) 664-3786 or his Administrative Assistant, Anne Eddy, (360) 586-3111. The commissioner will form small groups comprised of affected parties to develop a new chapter of rules for managed care plans.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication. Rule proposals and comments will be periodically posted to the Office of the Insurance Commissioner's web site at http://www.wa.gov/ins. Send comments referencing the managed care rules to Kacy Brandeberry, P.O. Box 40255, Olympia, WA 98504-0255, Internet inscomr@aol.com. Deadline for Comments: September 1, 1997.

July 30, 1997

Deborah Senn