WSHA Comments on Surprise Billing Rule

November 12, 2019

On Monday, WSHA submitted comments on the Office of the Insurance Commissioner’s (OIC) proposed rule implementing House Bill 1065, the Balance Billing Protection Act (BBPA) enacted during the 2019 legislative session. Overall, WSHA is pleased with thoughtfulness and the direction of the rule. The proposed rule includes several changes specifically requested by WSHA, including:

  • The change to definition of median rate to provide more clear instructions for the calculation. WSHA believed an incorrect definition in a prior version of the rule would understate actual median payment amounts.
  • The change to definition of in-network provider under single case agreements to include only the parties to the agreement.
  • The inclusion of the X12 271 standard transaction to determine applicability of patient’s coverage to the BBPA.

In its comments, WSHA asked for additional clarity regarding:

  • Enforcement criteria;
  • The requirement to post provider networks for contracts prior to January 1, 2020; and
  • Enforcement for self-funded groups that opt-in.

OIC is still working to finalize details regarding arbitration, related data reports, and self-funded plan election process.  WSHA will provide more information as it becomes available.


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