WSR 12-19-082




[ Insurance Commissioner Matter No. R 2012-24 -- Filed September 18, 2012, 2:31 p.m. ]

     Subject of Possible Rule Making: Amending WAC 284-43-330 Participating provider contracts.

     Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.44.050, 48.44.070, 48.46.030, 48.46.200, 48.46.243.

     Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Currently, RCW 48.44.070, 48.46.030, and 48.46.243 require carriers to file participating provider agreements with the commissioner. The commissioner proposes to amend WAC 284-43-330(1) to make it consistent with these underlying statutory requirements by requiring carriers to submit information about provider or facility compensation. In addition to reconciling the rule to the underlying law, this change will help the commissioner determine if reimbursement methods incentivize health homes, chronic care management, or care coordination for enrollees with complex, high-cost, or multiple chronic conditions, which is a component of certification as a qualified health plan (QHP) eligible to participate in the exchange.

     Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.

     Process for Developing New Rule: Submit written comments by October 23, 2012, to Donna Dorris,, fax (360) 586-3109.

     Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Donna Dorris,, P.O. Box 40254, Olympia, WA 98504, fax (360) 586-3109.

September 18, 2012

Mike Kreidler

Insurance Commissioner