RCW 48.43.750 Health care provider credentialing applications—Use of electronic database by health carriers. (1)(a) A health carrier must use the database selected pursuant to RCW 48.165.035 to accept and manage credentialing applications from health care providers. A health carrier may not require a health care provider to submit credentialing information in any format other than […]
RCW 48.43.755 Health care provider credentialing applications—Use of electronic database by providers. (1) When submitting a credentialing application to a health carrier, a health care provider shall submit the application to health carriers using the database selected pursuant to RCW 48.165.035. (2) A health care provider shall update credentialing information as necessary to provide for […]
RCW 48.43.757 Health care provider credentialing applications—Reimbursement requirements. (1) If a carrier approves a health care provider’s credentialing application, upon completion of the credentialing process, the carrier must reimburse a health care provider under the following circumstances: (a) When credentialing a new health care provider through a new provider contract, the carrier must reimburse the […]
RCW 48.43.760 Opioid use disorder—Coverage without prior authorization. For health plans issued or renewed on or after January 1, 2020, a health carrier shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, […]
RCW 48.43.761 Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review. (1) Except as provided in subsection (2) of this section, a health plan issued or renewed on or after January 1, 2021, may not require an enrollee to obtain prior authorization for withdrawal management services or inpatient or residential substance use disorder […]
RCW 48.43.762 Opioid overdose reversal medication bulk purchasing and distribution program. For health plans issued or renewed on or after January 1, 2023, health carriers must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational. A health plan may not impose enrollee cost […]
RCW 48.43.765 Health carrier network adequacy—Mental health and substance abuse treatment. (1) The commissioner shall amend his or her rules on electronic provider directories to require health carriers to include a notation when any mental health provider or substance abuse provider is closed to new patients. (2) Beginning January 1, 2020, a health carrier shall […]
RCW 48.43.770 Individual market health plan availability—Annual report. The commissioner shall submit an annual report to the appropriate committees of the legislature on the number of health plans available per county in the individual market. [ 2019 c 364 § 7.]
RCW 48.43.775 Qualified health plan participation—Reimbursement rate for other health plans. A carrier may not require a provider or facility participating in a qualified health plan under RCW 41.05.410 to, as a condition of participation in a qualified health plan under RCW 41.05.410, accept a reimbursement rate for other health plans offered by the carrier […]
RCW 48.43.780 Insulin drugs—Cap on enrollee’s required payment amount—Cost-sharing requirements. (Effective until January 1, 2023.) (1) Except as required in subsection (2) of this section, a health plan issued or renewed on or after January 1, 2021, that provides coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that […]
RCW 48.43.785 COVID-19 personal protective equipment expenses—Health care provider reimbursement. (Contingent expiration date.) (1) For the duration of the federal public health emergency related to COVID-19, a health benefit plan shall reimburse a health care provider who bills for incurred personal protective equipment expenses as a separate expense, using the American medical association’s current procedural […]
RCW 48.43.790 Behavioral services—Next-day appointments. Health plans issued or renewed on or after January 1, 2023, must make next-day appointments available to enrollees experiencing urgent, symptomatic behavioral health conditions to receive covered behavioral health services. The appointment may be with a licensed provider other than a licensed behavioral health professional, as long as that provider […]
RCW 48.43.795 Qualified health plans—Acceptance of premium and cost-sharing assistance. For qualified health plans offered on the exchange, a carrier shall: (1) Accept payments for enrollee premiums or cost-sharing assistance under RCW 43.71.110 or as part of a sponsorship program under RCW 43.71.030(4). Nothing in this subsection expands or restricts the types of sponsorship programs […]
RCW 48.43.800 Primary care expenditures assessment—Review. The commissioner may include an assessment of carriers’ primary care expenditures in the previous plan year or anticipated for the upcoming plan year in its reviews of health plan form or rate filings. In conducting the review, the commissioner must consider any definition of primary care expenditures and any […]
RCW 48.43.805 Prescription drug upper payment limit—Rules. (1) For health plans issued or renewed on or after January 1, 2024, if the prescription drug affordability board, as established in chapter 70.405 RCW, establishes an upper payment limit for a prescription drug pursuant to RCW 70.405.050, a carrier must provide sufficient information, as determined by the […]
RCW 48.43.810 Biomarker testing—Standards—Construction. (1) Health plans issued or renewed on or after January 1, 2023, shall exempt an enrollee from prior authorization requirements for coverage of biomarker testing for either of the following: (a) Stage 3 or 4 cancer; or (b) Recurrent, relapsed, refractory, or metastatic cancer. (2) For purposes of this section, “biomarker […]
RCW 48.43.815 Donor human milk—Standards. (1) For group health plans other than small group health plans issued or renewed on or after January 1, 2023, a health carrier shall provide coverage for medically necessary donor human milk for inpatient use when ordered by a licensed health care provider with prescriptive authority or an international board […]
RCW 48.43.820 Consolidated appropriations act enforcement—Implementation of federal regulations. The commissioner is authorized to enforce provisions of P.L. 116-260 (enacted December 27, 2020, as the consolidated appropriations act of 2021) and implementing federal regulations in effect on March 31, 2022, that are applicable to or regulate the conduct of carriers issuing health plans or grandfathered […]
