Revised Code of Washington
Chapter 48.43 - Insurance Reform.
48.43.5051 - Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.

RCW 48.43.5051
Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.

(1) The commissioner shall:
(a) Develop a process for the regular collection of information from carriers on requests for confidential communications pursuant to RCW 48.43.505 for the purposes of monitoring compliance, including monitoring:
(i) The effectiveness of the process described in RCW 48.43.505 in allowing protected individuals to redirect insurance communications, the extent to which protected individuals are using the process, and whether the process is working properly; and
(ii) The education and outreach activities conducted by carriers to inform enrollees about their right to confidential communications;
(b) Establish a process for ensuring compliance; and
(c) Develop rules necessary to implement chapter 56, Laws of 2019.
(2) The commissioner shall work with stakeholders to develop and make available to the public a standardized form that a protected individual may submit to a carrier to make a confidential communications request. At minimum, this form must:
(a) Inform a protected individual about the protected individual's right to confidential communications;
(b) Allow a protected individual to indicate where to redirect communications, including a specified physical or email address or specified telephone number; and
(c) Include a disclaimer that it may take up to three business days from the date of receipt for a carrier to process the form.

[ 2019 c 56 § 4.]
NOTES:

Findings—Declarations—2019 c 56: "The legislature finds and declares:
(1) All people deserve the right to choose the health services that are right for them, and the right to confidential access to those health services.
(2) When people are assured of the ability to confidentially access health care services, they are more likely to seek health services, disclose health risk behaviors to a clinician, and return for follow-up care.
(3) When denied confidential access to needed care, people may delay or forgo care, leading to higher rates of unprotected sex, unintended pregnancy, untreated sexually transmitted infections, and mental health issues, or they may turn to public health safety net funds or free clinics to receive confidential care—important resources that should be reserved for people who do not have insurance coverage." [ 2019 c 56 § 1.]


Effective date—2019 c 56: "This act takes effect January 1, 2020." [ 2019 c 56 § 8.]

Structure Revised Code of Washington

Revised Code of Washington

Title 48 - Insurance

Chapter 48.43 - Insurance Reform.

48.43.001 - Intent.

48.43.005 - Definitions.

48.43.007 - Availability of price and quality information—Transparency tools for members—Requirements.

48.43.008 - Enrollment in employer-sponsored health plan—Person eligible for medical assistance.

48.43.009 - Health care sharing ministries.

48.43.012 - Health plans—Preexisting conditions—Rules.

48.43.01211 - Health plans—Eligibility—Health status-related factors—Rules.

48.43.0122 - Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.

48.43.0123 - Health plans—Rescission of coverage—Rules.

48.43.0124 - Health plans—Cost sharing for essential health benefits—Rules.

48.43.0125 - Essential health benefits—Annual or lifetime dollar limits.

48.43.0126 - Summary of benefits and explanation of coverage—Standards and requirements—Notice of modification—Fines—Standards for definitions of health insurance terms—Rules.

48.43.0127 - Group health plans—Waiting period—Rules.

48.43.0128 - Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022—Prohibited discrimination—Rules.

48.43.016 - Utilization management standards and criteria—Health carrier requirements—Definitions.

48.43.0161 - Prior authorization practices—Carrier annual reporting requirements—Commissioner's standardized report.

48.43.021 - Personally identifiable health information—Restrictions on release.

48.43.022 - Enrollee identification card—Social security number restriction.

48.43.023 - Pharmacy identification cards—Rules.

48.43.028 - Eligibility to purchase certain health benefit plans—Small employers and small groups.

48.43.035 - Group health benefit plans—Guaranteed issue and continuity of coverage—Exceptions.

48.43.038 - Individual health plans—Guarantee of continuity of coverage—Exceptions.

48.43.039 - Grace period—Notification or information—Information concerning delinquencies or nonpayment of premiums—Defined.

48.43.041 - Individual health benefit plans—Mandatory benefits.

48.43.043 - Colorectal cancer examinations and laboratory tests—Required benefits or coverage.

48.43.045 - Health plan requirements—Annual reports—Exemptions.

48.43.047 - Health plans—Minimum coverage for preventative services—No cost-sharing requirements.

48.43.049 - Health carrier data—Information from annual statement—Format prescribed by commissioner—Public availability.

48.43.055 - Procedures for review and adjudication of health care provider complaints—Requirements.

48.43.059 - Payments made by a second-party payment process—Definition.

48.43.065 - Right of individuals to receive services—Right of providers, carriers, and facilities to refuse to participate in or pay for services for reason of conscience or religion—Requirements.

48.43.071 - Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.

48.43.072 - Required reproductive health care coverage—Restrictions on copayments, deductibles, and other form of cost sharing.

48.43.0725 - Reproductive health plan coverage—Immediate postpartum contraception devices.

48.43.073 - Required abortion coverage—Limitations.

48.43.074 - Qualified health plans—Single invoice billing—Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.

48.43.078 - Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.

48.43.081 - Anatomic pathology services—Payment for services—Definitions.

48.43.083 - Chiropractor services—Participating provider agreement—Health carrier reimbursement.

48.43.085 - Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.

48.43.087 - Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.

48.43.091 - Health carrier coverage of outpatient mental health services—Requirements.

48.43.093 - Health carrier coverage of emergency medical services—Requirements—Conditions.

48.43.094 - Pharmacist provided services—Health plan requirements.

48.43.096 - Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.

48.43.097 - Filing of financial statements—Every health carrier.

48.43.105 - Preparation of documents that compare health carriers—Immunity—Due diligence.

48.43.115 - Maternity services—Intent—Definitions—Patient preference—Clinical sovereignty of provider—Notice to policyholders—Application.

48.43.125 - Coverage at a long-term care facility following hospitalization—Definition.

48.43.176 - Eosinophilic gastrointestinal associated disorder—Elemental formula.

48.43.180 - Denturist services.

48.43.185 - General anesthesia services for dental procedures.

48.43.190 - Payment of chiropractic services—Parity.

48.43.195 - Contraceptive drugs—Twelve-month refill coverage.

48.43.200 - Disclosure of certain material transactions—Report—Information is confidential.

48.43.205 - Material acquisitions or dispositions.

48.43.210 - Asset acquisitions—Asset dispositions.

48.43.215 - Report of a material acquisition or disposition of assets—Information required.

48.43.220 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

48.43.225 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

48.43.290 - Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.

48.43.600 - Overpayment recovery—Carrier.

48.43.605 - Overpayment recovery—Health care provider.

48.43.650 - Fixed payment insurance products—Commissioner's annual report.

48.43.670 - Plan or contract renewal—Modification of wellness program.

48.43.680 - Lifetime limit on transplants—Definition.

48.43.690 - Assessments under RCW 70.290.040 considered medical expenses.

48.43.700 - Exchange—Plans that a carrier must offer—Review—Rules.

48.43.705 - Plans offered outside of exchange.

48.43.710 - Certification as qualified health plan not an exemption.

48.43.715 - Individual and small group market—Selection of benchmark plan—Minimum requirements—Criteria—List of state-mandated health benefits.

48.43.720 - Reinsurance and risk adjustment programs—Affordable care act—Rules.

48.43.725 - Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.

48.43.730 - Carrier must file provider contracts and compensation agreements with commissioner—Approval or disapproval—Confidentiality—Hearings—Rules—Definitions.

48.43.731 - Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.

48.43.733 - Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.

48.43.734 - Health carrier rate filings—Review of surplus, capital, and profit levels.

48.43.735 - Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.

48.43.740 - Dental only plan—Emergency dental conditions—Definitions.

48.43.743 - Dental only plan—Annual data statement—Contents—Public use—Definition.

48.43.750 - Health care provider credentialing applications—Use of electronic database by health carriers.

48.43.755 - Health care provider credentialing applications—Use of electronic database by providers.

48.43.757 - Health care provider credentialing applications—Reimbursement requirements.

48.43.760 - Opioid use disorder—Coverage without prior authorization.

48.43.761 - Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.

48.43.762 - Opioid overdose reversal medication bulk purchasing and distribution program.

48.43.765 - Health carrier network adequacy—Mental health and substance abuse treatment.

48.43.770 - Individual market health plan availability—Annual report.

48.43.775 - Qualified health plan participation—Reimbursement rate for other health plans.

48.43.780 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

48.43.785 - COVID-19 personal protective equipment expenses—Health care provider reimbursement.

48.43.790 - Behavioral services—Next-day appointments.

48.43.795 - Qualified health plans—Acceptance of premium and cost-sharing assistance.

48.43.800 - Primary care expenditures assessment—Review.

48.43.805 - Prescription drug upper payment limit—Rules.

48.43.810 - Biomarker testing—Standards—Construction.

48.43.815 - Donor human milk—Standards.

48.43.820 - Consolidated appropriations act enforcement—Implementation of federal regulations.

48.43.300 - Definitions.

48.43.305 - Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.

48.43.310 - Company action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.

48.43.315 - Regulatory action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.

48.43.320 - Authorized control level event—Commissioner's options.

48.43.325 - Mandatory control level event—Commissioner's duty—Regulatory control.

48.43.330 - Carrier's right to hearing—Request by carrier—Date set by commissioner.

48.43.335 - Confidentiality of RBC reports and plans—Use of certain comparisons prohibited—Certain information intended solely for use by commissioner.

48.43.340 - Powers or duties of commissioner not limited—Rules.

48.43.345 - Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.

48.43.350 - No liability or cause of action against commissioner or department.

48.43.355 - Notice by commissioner to carrier—When effective.

48.43.360 - Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.

48.43.366 - Self-funded multiple employer welfare arrangements.

48.43.370 - RBC standards not applicable to certain carriers.

48.43.400 - Prescription drug utilization management—Definitions.

48.43.410 - Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.

48.43.420 - Prescription drug utilization management—Exception request process—Conditions, requirements, and time frames for approval or denial of requests—Emergency fill coverage—Notice of new policies and procedures.

48.43.430 - Prescription medication—Maximum charge at point of sale—Requirements.

48.43.435 - Prescription medication—Cost-sharing calculation—Application—Rules.

48.43.500 - Intent—Purpose—2000 c 5.

48.43.505 - Enrollee's and protected individual's right to privacy and confidential services—Health carrier or insurer duties—Requests for confidential communications—Rules.

48.43.5051 - Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.

48.43.510 - Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.

48.43.515 - Access to appropriate health services—Enrollee options—Rules.

48.43.517 - Enrollment of child participating in medical assistance program—Employer-sponsored health plan.

48.43.520 - Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.

48.43.525 - Prohibition against retrospective denial of health plan coverage—Rules.

48.43.530 - Requirement for carriers to have comprehensive grievance and appeal processes—Carrier's duties—Procedures—Appeals—Rules.

48.43.535 - Independent review of health care disputes—System for using certified independent review organizations—Rules.

48.43.537 - Health care disputes—Certifying independent review organizations—Application—Restrictions—Maximum fee schedule for conducting reviews—Rules.

48.43.540 - Requirement to designate a licensed medical director—Exemption.

48.43.545 - Standard of care—Liability—Causes of action—Defense—Exception.

48.43.550 - Delegation of duties—Carrier accountability.

48.43.902 - Effective date—1996 c 312.

48.43.904 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.