State and Stakeholders Continue Work to Align State and Federal Balance Billing Laws

September 1, 2021

Staff from the state’s Office of the Insurance Commissioner (OIC) have been conducting stakeholder calls and solicited comments to determine what changes to law or rules may be necessary to align the state’s existing Balance Billing Protection Act (BBPA) and the federal No Surprises Act (NSA). WSHA is actively involved in the stakeholder process and provided comments. While the state and federal balance billing laws are in some respects conceptually similar, there are major differences in both their scope and in many of their specifics. WSHA has received input from our members. Among the topics under consideration:

  • Retention of the BBPA “commercially reasonable” standard for insurer payments to out-of-network providers. WSHA supports retention of the BBPA standard as it provides greater protections from insurer underpayment than does the NSA standard.
  • Possible adoption of NSA provisions allowing the patient to waive balance billing protections for certain out-of-network services. WSHA is neutral on this provision, as it does not generally apply to hospitals and ancillary providers. WSHA commented that hospitals should not be required to obtain waivers on behalf of noncontracted independent provider groups.
  • Expansion of the BBPA definition of emergency services to include post-stabilization inpatient services, to match the NSA definition. WSHA is generally supportive of alignment between the BBPA and NSA on this issue.
  • Retention of the BBPA provision allowing self-funded employer groups to opt into the BBPA payment requirements and patient protections. WSHA supports retention of the BBPA opt-in provision provided self-funded groups that do so are limited to the BBPA payment and dispute resolution provisions.

A stakeholder draft of proposed legislative and/or rule changes is expected sometime in October. (Andrew Busz,


Contact Us

Washington State Hospital Association
999 Third Avenue
Suite 1400
Seattle, WA 98104

Map / Directions

206.281.7211 phone
206.283.6122 fax

Staff List