Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.49.003 Findings—Intent—2019 c 427.
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(1) The legislature finds that:(a) Consumers receive surprise bills or balance bills for services provided at nonparticipating facilities, by nonparticipating health care providers at in-network facilities, and by ground ambulance services organizations;(b) Consumers must not be …
RCW 48.49.005 Short title.
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This chapter may be known and cited as the balance billing protection act.[ 2019 c 427 s 4.]
RCW 48.49.010 Definitions.
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The definitions in RCW 48.43.005 apply throughout this chapter unless the context clearly requires otherwise.[ 2019 c 427 s 5.]
RCW 48.49.020 Balance billing—When prohibited—Carrier's duty to hold an enrollee harmless from balance billing under certain circumstances.
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(1) A nonparticipating provider or facility may not balance bill an enrollee for the following health care services as provided in section 2799A-1(b) of the public health service act (42 U.S.C. Sec. 300gg-111(b)) and implementing federal regulations in effect on March 31, 2022:(a…
RCW 48.49.030 Enrollee's obligation to pay for services.
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(1) If an enrollee receives emergency services from a behavioral health emergency services provider under the circumstances described in RCW 48.49.020(3):(a) The enrollee satisfies his or her obligation to pay for the health care services if he or she pays the in-network cost-sha…
RCW 48.49.040 Dispute resolution process—Determination of commercially reasonable payment amount.
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(1) Effective July 1, 2023, or a later date determined by the commissioner, services described in RCW 48.49.020(1) other than air ambulance services are subject to the independent dispute resolution process established in sections 2799A-1 and 2799A-2 of the public health service …
RCW 48.49.060 Notice of consumer rights—Development of standard template language by commissioner.
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(1) The commissioner, in consultation with health carriers, health care providers, health care facilities, behavioral health emergency services providers, ground ambulance services organizations, and consumers, must develop standard template language for a notice of consumer righ…
RCW 48.49.070 Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists.
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(1)(a) A hospital, ambulatory surgical facility, behavioral health emergency services provider, or ground ambulance services organization must post the following information on its website, if one is available:(i) The listing of the carrier health plan provider networks with whic…
RCW 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.
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(1)(a) A health care provider must provide the following information on its website, if one is available:(i) The listing of the carrier health plan provider networks with which the provider contracts, based upon the information provided by the carrier pursuant to RCW 48.43.730(7)…
RCW 48.49.090 Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information.
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(1) A carrier must update its website and provider directory no later than thirty days after the addition or termination of a facility or provider.(2) A carrier must provide an enrollee with:(a) A clear description of the health plan's out-of-network health benefits;(b) The notic…
RCW 48.49.100 Pattern of unresolved violations—Enforcement action by department of health or appropriate disciplining authority.
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(1) If the commissioner has cause to believe that any health care provider, hospital, ambulatory surgical facility, or behavioral health emergency services provider, has engaged in a pattern of unresolved violations of RCW 48.49.020 or 48.49.030, the commissioner may submit infor…
RCW 48.49.110 Rule-making authority.
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(1) The commissioner may adopt rules to implement and administer this chapter, including rules governing the dispute resolution process established in RCW 48.49.040.(2) The commissioner may adopt rules to adopt or incorporate by reference without material change federal regulatio…
RCW 48.49.120 No application of chapter to health plans under chapter 74.09 RCW.
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This chapter does not apply to health plans that provide benefits under chapter 74.09 RCW.[ 2019 c 427 s 22.]
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.
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As authorized in 45 C.F.R. Sec. 149.30 as in effect on March 31, 2022, the provisions of this chapter apply to a self-funded group health plan whether governed by or exempt from the provisions of the federal employee retirement income security act of 1974 (29 U.S.C. Sec. 1001 et …
RCW 48.49.135 Determining the adequacy of provider networks—Required considerations.
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(1) When determining the adequacy of a proposed provider network or the ongoing adequacy of an in-force provider network, the commissioner must review the carrier's proposed provider network or in-force provider network to determine whether the network includes a sufficient numbe…
RCW 48.49.140 Liberal construction of chapter to promote public interest.
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This chapter must be liberally construed to promote the public interest by ensuring that consumers are not billed out-of-network charges and do not receive additional bills from providers under the circumstances described in RCW 48.49.020.[ 2019 c 427 s 24.]
RCW 48.49.160 Allowed amounts paid to nonparticipating providers.
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(1)(a) Until July 1, 2023, or a later date determined by the commissioner under RCW 48.49.040, the allowed amount paid to a nonparticipating provider for health care services described under RCW 48.49.020(1) other than air ambulance services shall be a commercially reasonable amo…
RCW 48.49.170 Application of state and federal requirements—Applicability information access—Waivers prohibited.
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(1) Carriers must make available through electronic and other methods of communication generally used by a provider or facility to verify enrollee eligibility and benefits information regarding whether an enrollee's health plan is subject to the requirements of this chapter or se…
RCW 48.49.180 Commissioner authority—Enforcement—Penalties.
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The commissioner is authorized to enforce provisions of P.L. 116-260 (enacted December 27, 2020, as the consolidated appropriations act of 2021) that are applicable to or regulate the conduct of carriers issuing health plans or grandfathered health plans to residents of Washingto…
RCW 48.49.200 Ground ambulance services organizations—Payments—Prohibition on waivers.
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(1) For health plans issued or renewed on or after January 1, 2025, a nonparticipating ground ambulance services organization may not balance bill an enrollee for covered ground ambulance services.(2) If an enrollee receives covered ground ambulance services:(a) The enrollee sati…
RCW 48.49.205 Ground ambulance services organizations—Rates—Public database.
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(1) Each local governmental entity that has established or contracted for rates for ground ambulance services provided in their geographic service area must submit the rates to the office of the insurance commissioner, in the form and manner prescribed by the commissioner for pur…
RCW 48.49.210 Ground ambulance services organizations—Commissioner's review—Report.
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(1) The commissioner must undertake a process to review the reasonableness of the percentage of the medicare rate established in RCW 48.49.200 and any trends in changes to ground ambulance services rates set by local governmental entities and ground ambulance services organizatio…
RCW 48.49.900 Effective date—2019 c 427.
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Except for section 26 of this act, this act takes effect January 1, 2020.[ 2019 c 427 s 31.]