2016 legislative recap

Ending emergency department surprise billing - HB 2447 (leg.wa.gov)

The bill did not pass the 2016 legislative session, but remains a high priority for Commissioner Kreidler. He will continue to work on a solution to surprise billing, including proposing legislation again in 2017.

This legislation would have protected consumers from being balance-billed by out-of-network health care providers for services they receive at an emergency room. If they receive emergency care at a hospital that is in their plan's network, but the provider is out of their network, the consumer would not pay more than if the provider was in-network.

Medical providers would be able to negotiate with the health insurers above the insurer's usual out-of-network rate and any disputes between the two parties would be settled through arbitration.

Read more about what surprise billing is, what you can do about it and how it has affected real Washington consumers.

Standard Valuation and Standard Nonforfeiture Model Act - SB 5180 (leg.wa.gov)

Signed by Governor Inslee on March 31, 2016.

Principle based reserving (PBR) will allow us to see detailed financial information from life insurance companies at the beginning of the filing process, rather than later during financial examinations. The financial information must be submitted annually.

This will allow companies to use the actual experience of life insurance policyholders rather than having them rely on a formulaic table when calculating their claims reserves. It is likely that enough states have now adopted PBR that it will become a requirement in order for states to maintain their accreditation with the National Association of Insurance Commissioners.

Maintaining confidentiality of provider agreement compensation exhibits - HB 2332 (leg.wa.gov)

Signed by Governor Inslee on March 31, 2016.

State law, (RCW 48.43.730) (leg.wa.gov), made provider compensation exhibits (reimbursement agreements between providers and insurance companies) confidential and not subject to public disclosure, when they are filed with the OIC. This confidentiality protection was set to sunset on July 1, 2017.

This bill removes that sunset provision and keeps provider compensation agreements with insurance companies confidential.

Registration of Third Party-Administrators (TPAs) and benefits managers - HB 2445/SB 6447(leg.wa.gov)

This legislation would have required all TPAs and medical benefit managers to register with the OIC. Currently, TPAs and ┬ábenefit managers are not regulated in Washington State. Over 40 states require TPAs to register with their state’s insurance regulator but none register benefit managers.

As health insurance companies increasingly rely on these companies to make critical decisions about when and how often patients can access health care benefits, it is critical that we know what services they are providing and who they are providing them for.

This legislation did not pass the 2016 legislative  session, but will continue to be a high priority for the OIC.

Moving the Independent Review Organizations (IROs) oversight - HB 2326 (leg.wa.gov)

Signed by Governor Inslee on March 31, 2016.

This legislation moves the oversight of health care IROs from the Department of Health to the Office of the Insurance Commissioner (OIC). Under this bill, the OIC is responsible for certifying all IROs and IROs must file their case reports directly with the OIC versus sending them to the insurers to file on their behalf.

Allowing small pharmacies to appeal their rate of reimbursement for prescription drugs by pharmacy benefit managers (PBMs) - SB 5857 (leg.wa.gov)

Signed by Governor Inslee on April 1, 2016

This legislation creates a secondary appeals process, overseen by the OIC, for small pharmacies to contest the price PBMs set for reimbursing them for prescription drugs. In addition, the legislation moves the registration of PBMs to the OIC and gives enforcement authority over the appeals process. Finally, the legislation requires us to conduct an intensive study on the pharmacy supply chain and report to the legislature by Nov. 1, 2016

Updated 04/28/2016

See also

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