The Washington Office of the Insurance Commissioner (OIC) released its CR-102 proposed rule implementing House Bill 1065, the Balance Billing Protection Act (BBPA). The proposed rule provides specifics on how OIC will implement and enforce the BBPA.
WSHA will be submitting comments on the CR-102 and is pleased to see many of our previous suggestions incorporated into this draft. While state agencies do not usually make significant changes to the CR-102, we do want to comment on any major issues you identify. Please contact Andrew Busz at email@example.com or (206) 216-2533 with your comments or concerns. OIC will accept comments on the proposed rule through November 4 and will conduct a public hearing on November 5. More information regarding comment submission and the hearing is on the OIC’s BBPA rulemaking page.
Major provisions in the proposed rule includes:
- An improved definition of median for purposes of the BBPA. The new definition ensures the median calculation reflects the distribution of claims payments rather than the distribution of rates amounts, a change specifically requested by WSHA. While not specifically mentioned in the rule, the reports will reflect the nine geographic rating areas used by OIC. WSHA and WSMA strongly advocated for the median amounts on the reports to reflect the state’s geographically diverse regions while some health plans were advocating for as few as two regions. We believe the decision to use the nine OIC rating regions is a fair compromise and consistent with the language in the BBPA.
- Specifics on the dispute resolution process, the electronic method for facilities and providers to look up whether an enrollee’s health plan is subject to BBPA, the opt-in process for self-funded groups, and notice and transparency provisions. The transparency and notice provisions are generally unchanged from the last stakeholder draft. While the requirements place some burden on hospitals, providers and health plans, we do not think they will disrupt patient care.
- A new requirement that providers complete all required elements of the claim submission. We believe the purpose of this provision is to ensure providers identify in the appropriate location the facility name where the service was performed so health plans can determine whether it was performed at an in-network or out of network facility.
- A requirement that health plans clearly specify the networks the contract applies to in their provider contracts. This is to ensure facilities and providers can accurately provide information to consumers via their web sites.