Date of Adoption: April 23, 2003.
Purpose: The adopted rule is intended to reduce the burden on network reporting and increase the consistency of data. The rule clarifies the information to be reported, limits the reporting to necessary information, extends the deadline for reporting, and changes the manner in which the reports must be filed.
Citation of Existing Rules Affected by this Order: Amending WAC 284-43-220.
Statutory Authority for Adoption: RCW 48.02.060, 48.18.120, 48.20.450, 48.20.460, 48.43.515, 48.44.050, 48.46.030, 48.46.200.
Other Authority: RCW 48.42.100, 48.43.515, 48.46.030.
Adopted under notice filed as WSR 03-03-134 on January 22, 2003.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: Thirty-one days after filing.
April 23, 2003
AMENDATORY SECTION(Amending Matter No. R 99-2, filed 1/24/00, effective 1/1/01)
WAC 284-43-220 Network reports -- Format. ((
January 1, 1999, and by January 31st of every subsequent
year,)) Each health carrier (( shall provide a description of
each of its networks to the commissioner. In describing its
network, each carrier shall include an explanation of its
established access standards, noting the criteria used to
measure the standards. For example, a carrier should indicate
whether travel distances or driving times are used to
determine accessibility. In addition, each carrier shall
indicate which providers are classified as primary care
providers, obstetric and women's health care providers)) must
file with the commissioner an access plan, Provider Network
Form A, Network Enrollment Form B and Geographic Network
Beginning January 1, 1999, each health carrier
shall provide the insurance commissioner with:
(a) An annual)) Access plan. A health carrier must describe each of its networks in an access plan as prescribed by WAC 284-43-210.
(2) Provider Network Form A. A carrier must file an
or hard copy paper)) report of all participating
providers by network (( and monthly updates)). This report
(( shall)) must contain all (( the)) data items shown in (( the
table. (Form A.))) Provider Network Form A prescribed by and
available from the commissioner. Updated reports must be
filed each month. Filing of this data satisfies the reporting
requirements of RCW 48.44.080 and the requirements of RCW 48.46.030 relating to filing of notices that describes changes
in the provider network.
(b) An annual electronic or hard copy paper report
indicating)) (3) Network Enrollment Form B. By March 31,
2004, and every year thereafter, a carrier must prepare an
electronic report showing the total number of covered persons
who were entitled to health care services during each month of
the year, excluding nonresidents(( , by line of business, by
product (with identifying form number filed with this office,
if appropriate), by county, and by sex. The report shall
conform to the table. (Form B.)
(2) In addition to the provider and covered persons reports, each carrier shall file annual reports meeting the standards below and shall)). A separate report must be filed for each network by line of business. The report must contain all data items shown in and conform to the format of Network Enrollment Form B prescribed by and available from the commissioner.
(4) Geographic Network Report. By March 31st of every
year, a carrier also must file an electronic or hard copy
paper report meeting the standards below. The carrier must
update the reports whenever a material change in ((
carrier's provider network occurs that significantly affects
the ability of covered persons to access covered services. Each carrier (( shall)) must file for each network (( (with
identifying form number(s) filed with this office, if
appropriate))), using a network accessibility analysis system,
such as GeoNetworks or any other similar system:
(a) A map showing the location of covered persons and
primary care providers with a differentiation between single
and multiple provider locations((
(b) An access table illustrating the relationship between primary care providers and covered persons as of December of each year by county, including at a minimum:
(ii))) Total number of covered persons((
(iii))) (ii) Total number of primary care
providers(( .)) (or, if the plan is a Preferred Provider
Organization style of managed care, the total number of
(iv))) (iii) Number of covered persons meeting the
carrier's self defined access standard(( .));
(v))) (iv) Percentage of covered persons meeting the
carrier's self defined access standard(( .)); and
(vi))) (v) Average distance to at least one primary
care provider for its covered persons(( .)); and
A list indicating alphabetically by county and by
(iii))) An alphabetical list by county and city showing:
(i) Total number of covered persons;
(iv))) (ii) Total number of primary care providers (or,
if the plan is a Preferred Provider Organization style of
managed care, the total number of contracted providers);
(v))) (iii) Total number of obstetric and women's
health care providers;
(vi))) (iv) Total number of specialists;
(vii))) (v) Total number of nonphysician providers by
(viii))) (vi) Total number of hospitals; and
(ix))) (vii) Total number of pharmacies.
(3))) (5) A carrier may vary the method of reporting
required under subsection (( (2))) (4) of this section upon
written request and subsequent written approval by the
commissioner (( after a showing by)). In the request, the
carrier must show that the carrier does not use or does not
have easy access to electronic or data systems permitting the
method of reporting required without incurring substantial
(6) For purposes of this section:
(a) "Line of business" means either individual, small group or large group coverage;
(b) "Network" means the group of participating providers and facilities providing health care services to a particular line of business.
Place illustration here.))
Place illustration here.))
Place illustration here.))
[Statutory Authority: RCW 48.02.060, 48.18.120, 48.20.450, 48.20.460, 48.30.010, 48.44.050, 48.46.030, 48.46.200. 00-04-034 (Matter No. R 99-2), § 284 -43-220, filed 1/24/00, effective 1/1/01. Statutory Authority: RCW 48.02.060, 48.20.450, 48.20.460, 48.30.010, 48.44.020, 48.44.050, 48.44.080, 48.46.030, 48.46.060(2), 48.46.200 and 48.46.243. 98-04-005 (Matter No. R 97-3), § 284-43-220, filed 1/22/98, effective 2/22/98.]