Washington · statute · Wash. Rev. Code ch. 48.49 · 23 active provisions
(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 placed in the middle of contractual disp…
This chapter may be known and cited as the balance billing protection act.
The definitions in RCW 48.43.005 apply throughout this chapter unless the context clearly requires otherwise.
(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) Emergency services provided to an enro…
(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-sharing amount specified in the enrollee's…
(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 act (42 U.S.C. Secs. 300gg-111 and 300gg…
(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 rights notifying consumers of their rights u…
(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 which the hospital, ambulatory surgical faci…
(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); and(ii) The notice of consumer rights…
(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 notice of consumer rights developed under RCW…
(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 information to the department of health or th…
(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 regulations adopted on or after March 31, 2022, t…
This chapter does not apply to health plans that provide benefits under chapter 74.09 RCW.
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 seq.) only if the self-funded group heal…
(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 number of contracted providers of emergency m…
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.
(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 amount, based on payments for the same or s…
(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 section 2799A-1 et seq. of the public heal…
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 Washington state on or after January 1, 2022. In…
(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 satisfies their obligation to pay for the gr…
(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 purposes of RCW 48.49.200. Rates establishe…
(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 organizations' billed charges. In conducting the re…
Except for section 26 of this act, this act takes effect January 1, 2020.