Revised Code of Washington
Chapter 48.49 - Balance Billing Protection Act.
48.49.003 - Findings—Intent—2019 c 427.

RCW 48.49.003
Findings—Intent—2019 c 427.

(1) The legislature finds that:
(a) Consumers receive surprise bills or balance bills for services provided at nonparticipating facilities or by nonparticipating health care providers at in-network facilities;
(b) Consumers must not be placed in the middle of contractual disputes between providers and health insurance carriers; and
(c) Facilities, providers, and health insurance carriers all share responsibility to ensure consumers have transparent information on network providers and benefit coverage, and the insurance commissioner is responsible for ensuring that provider networks include sufficient numbers and types of contracted providers to reasonably ensure consumers have in-network access for covered benefits.
(2) It is the intent of the legislature to:
(a) Ban balance billing of consumers enrolled in fully insured, regulated insurance plans and plans offered to public employees under chapter 41.05 RCW for the services described in RCW 48.49.020, and to provide self-funded group health plans with an option to elect to be subject to the provisions of this chapter;
(b) Remove consumers from balance billing disputes and require that nonparticipating providers and carriers negotiate nonparticipating provider payments in good faith under the terms of this chapter;
(c) Align Washington state law with the federal balance billing prohibitions and transparency protections in sections 2799A-1 et seq. of the public health service act (P.L. 116-260) and implementing federal regulations in effect on March 31, 2022, while maintaining provisions of this chapter that provide greater protection for consumers; and
(d) Provide an environment that encourages self-funded groups to negotiate payments in good faith with nonparticipating providers and facilities in return for balance billing protections.

[ 2022 c 263 § 6; 2019 c 427 § 1.]
NOTES:

Effective date—2022 c 263: See note following RCW 43.371.100.

Structure Revised Code of Washington

Revised Code of Washington

Title 48 - Insurance

Chapter 48.49 - Balance Billing Protection Act.

48.49.003 - Findings—Intent—2019 c 427.

48.49.005 - Short title.

48.49.010 - Definitions.

48.49.020 - Balance billing—When prohibited—Carrier's duty to hold an enrollee harmless from balance billing under certain circumstances.

48.49.030 - Enrollee's obligation to pay for services.

48.49.040 - Dispute resolution process—Determination of commercially reasonable payment amount.

48.49.050 - Commissioner's annual report on dispute resolution information regarding arbitration over commercially reasonable payment amounts.

48.49.060 - Notice of consumer rights—Development of standard template language by commissioner.

48.49.070 - Hospital, ambulatory surgical facility, or behavioral health emergency services provider—Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists.

48.49.080 - Health care provider—Requirement to provide certain information on website or upon consumer request—Requirement to submit network status information to carriers.

48.49.090 - Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information.

48.49.100 - Pattern of unresolved violations—Enforcement action by department of health or appropriate disciplining authority.

48.49.110 - Rule-making authority.

48.49.120 - No application of chapter to health plans under chapter 74.09 RCW.

48.49.130 - Application of chapter to self-funded group health plans that elect to participate in balance billing protection provisions—Annual notice to commissioner.

48.49.135 - Determining the adequacy of provider networks—Required considerations.

48.49.140 - Liberal construction of chapter to promote public interest.

48.49.160 - Allowed amounts paid to nonparticipating providers.

48.49.170 - Application of state and federal requirements—Applicability information access—Waivers prohibited.

48.49.180 - Commissioner authority—Enforcement—Penalties.

48.49.190 - Reports to legislature.

48.49.900 - Effective date—2019 c 427.