WSR 98-13-090



[Insurance Commissioner Matter No. R 98-17--Filed June 16, 1998, 4:48 p.m.]

Subject of Possible Rule Making: The commissioner will consider amending rules governing managed care plans under the recently adopted chapter 284-43 WAC. The commissioner may create subchapters relating to grievance and dispute resolution standards. Amendments to existing managed care rules may include changes to provider contract rules to address problems brought to the attention of the commissioner by health care professionals and health care facilities. In addition, amendments may be necessary to provisions governing health plans as a result of changes in or newly enacted federal laws, e.g., clarification of rules implementing the Health Insurance Portability and Accountability Act (HIPAA).

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.

Statutes Being Implemented: RCW 48.43.055, 48.44.020, 48.44.070, 48.46.040, 48.46.060, and 48.46.090.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Current rules governing health care carriers may need revision and/or new rule development to create a consistent and fair standards for grievance procedures in health plans. Some provisions of chapter 284-43 WAC may need correction as a consequence of changes in federal laws. Finally, new problems have been raised by the health care community relating to contracts between providers and health plans that require resolution.

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: Agency study; and the commissioner will form small groups comprised of affected parties to consider amending existing rules and/or developing new rules for managed care plans. For questions regarding substance of these rules, contact John Conniff, (360) 664-3786 or his administrative assistant, Ann Eddy (360) 586-3111.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication. Written comments should be submitted to Kacy Brandeberry, P.O. Box 40256, Olympia, WA 98504-0256, phone (360) 407-0729, FAX (360) 407-0186, Internet Deadline for comments August 15, 1998.

June 15, 1998

Greg J. Scully

Chief Deputy Commissioner

Legislature Code Reviser


Washington State Code Reviser's Office