reglab/housing_qa huggingface dataset:
WA Rev Code § 48.43.755 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.755 - Health care provider credentialing applications—Use of electronic database by providers.

RCW 48.43.755 Health care provider credentialing applications—Use of electronic database by providers.(1) When submitting a credentialing application to a health carrier, a health care provider shall submit the application to health carriers using the database selected pursuant to RCW 48.165.035.(2) A health care provider shall update credentialing information as necessary to provide for the purposes of recredentialing.(3) This section does not apply to providers practicing at entities that utilize credentialing delegation arrangements in the credentialing of their health care providers with health carriers.(4) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.(a) "Credentialing" has the same meaning as in RCW 48.43.750.(b) "Health care provider" has the same meaning as in *RCW 48.43.005(23)(a).(c) "Health carrier" has the same meaning as in RCW 48.43.005.[ 2016 c 123 § 2.]NOTES:*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (23) to subsection (24), and effective January 1, 2020, changing subsection (23) to subsection (26).Effective date—2016 c 123: See note following RCW 48.43.750.
WA Rev Code § 48.43.757 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.757 - Health care provider credentialing applications—Reimbursement requirements.

RCW 48.43.757 Health care provider credentialing applications—Reimbursement requirements.(1) If a carrier approves a health care provider's credentialing application, upon completion of the credentialing process, the carrier must reimburse a health care provider under the following circumstances:(a) When credentialing a new health care provider through a new provider contract, the carrier must reimburse the health care provider for covered services provided to the carrier's enrollee retroactively to the date of contract effectiveness if the credentialing process extends beyond the effective date of the new contract.(b) When credentialing a provider to be added to an approved and in-use provider contract where a relationship existed between the carrier and the health care provider or the entity for whom the health care provider is employed or engaged at the time the health care provider submitted the completed credentialing application, the carrier must reimburse the health care provider for covered health care services provided to the carrier's enrollees during the credentialing process beginning when the health care provider submitted a completed credentialing application to the carrier.(2) The health carrier must reimburse the health care provider at the contracted rate for the applicable health benefit plan that the health care provider would have been paid at the time the services were provided if the health care provider were fully credentialed by the carrier.(3) Nothing in this section requires reimbursement of health care provider-rendered services that are not benefits or services covered by the health carrier's health benefit plan.(4) Nothing in this section requires a health carrier to pay reimbursement for any covered medical services provided by a health care provider applicant if the health care provider's credentialing application is not approved or if the carrier and health care provider do not enter into a contractual relationship.[ 2020 c 4 § 2.]
WA Rev Code § 48.43.760 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.760 - Opioid use disorder—Coverage without prior authorization.

RCW 48.43.760 Opioid use disorder—Coverage without prior authorization.For health plans issued or renewed on or after January 1, 2020, a health carrier shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists.[ 2019 c 314 § 37.]NOTES:Declaration—2019 c 314: See note following RCW 18.22.810.
WA Rev Code § 48.43.762 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.762 - Opioid overdose reversal medication bulk purchasing and distribution program.

RCW 48.43.762 Opioid overdose reversal medication bulk purchasing and distribution program.For health plans issued or renewed on or after January 1, 2023, health carriers must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational. A health plan may not impose enrollee cost sharing related to opioid overdose reversal medication provided through the bulk purchasing and distribution program established in RCW 70.14.170.[ 2021 c 273 § 11.]NOTES:Rules—2021 c 273 §§ 7-12: See note following RCW 70.14.170.Findings—Intent—2021 c 273: See note following RCW 70.41.480.
WA Rev Code § 48.43.765 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.765 - Health carrier network adequacy—Mental health and substance abuse treatment.

RCW 48.43.765 Health carrier network adequacy—Mental health and substance abuse treatment.(1) The commissioner shall amend his or her rules on electronic provider directories to require health carriers to include a notation when any mental health provider or substance abuse provider is closed to new patients.(2) Beginning January 1, 2020, a health carrier shall prominently post the information listed in (a) through (e) of this subsection on its website in an easily understandable format and in a manner that any interested party may obtain the information:(a) Whether the health carrier classifies mental health treatment and substance abuse treatment as primary care or specialty care and the number of business days within which an enrollee must have access to covered mental health treatment services and substance abuse treatment services under network access standards pertaining to primary care or specialty care, as applicable, adopted by the commissioner;(b) Information on actions an enrollee may take if he or she is unable to access covered mental health treatment services or substance abuse treatment services within the requisite number of business days, including any tools or resources the carrier makes available to enrollees to assist them in finding available providers and information on how to file a complaint with the office of the insurance commissioner;(c) Any instances where the commissioner has taken disciplinary action against the health carrier for failing to comply with network access standards for covered mental health treatment services or substance abuse treatment services;(d) A link to the commissioner's report published under subsection (5) of this section; and(e) Resources for persons who are experiencing a mental health crisis including, but not limited to, information on the national suicide prevention lifeline.(3) The commissioner shall, by rule, specify a model format for the information required to be posted on a health carrier's website under subsection (2) of this section.(4) The commissioner may audit the information a health carrier provides under this section for accuracy.(5) The commissioner shall annually publish on the commissioner's website a report on the number of consumer complaints per licensed health carrier the commissioner received in the previous calendar year regarding consumers who were not able to access covered mental health treatment services or substance abuse treatment services within the time limits established by the commissioner for primary care or specialty care.[ 2019 c 11 § 1.]NOTES:Short title—2019 c 11: "This act may be known and cited as Brennen's law." [ 2019 c 11 § 2.]
WA Rev Code § 48.43.770 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.770 - Individual market health plan availability—Annual report.

RCW 48.43.770 Individual market health plan availability—Annual report.The commissioner shall submit an annual report to the appropriate committees of the legislature on the number of health plans available per county in the individual market.[ 2019 c 364 § 7.]
WA Rev Code § 48.43.775 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.775 - Qualified health plan participation—Reimbursement rate for other health plans.

RCW 48.43.775 Qualified health plan participation—Reimbursement rate for other health plans.A carrier may not require a provider or facility participating in a qualified health plan under RCW 41.05.410 to, as a condition of participation in a qualified health plan under RCW 41.05.410, accept a reimbursement rate for other health plans offered by the carrier at the same rate as the provider or facility is reimbursed for a qualified health plan under RCW 41.05.410.[ 2019 c 364 § 8.]
WA Rev Code § 48.43.780 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.780 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

RCW 48.43.780 Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements. (Expires January 1, 2023.)(1) Except as required in subsection (2) of this section, a health plan issued or renewed on or after January 1, 2021, that provides coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that an enrollee is required to pay for a covered insulin drug at an amount not to exceed one hundred dollars per thirty-day supply of the drug. Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing paid by an enrollee must be applied toward the enrollee's deductible obligation.(2) If the federal internal revenue service removes insulin from the list of preventive care services which can be covered by a qualifying health plan for a health savings account before the deductible is satisfied, for a health plan that provides coverage for prescription insulin drugs for the treatment of diabetes and is offered as a qualifying health plan for a health savings account, the carrier must establish the plan's cost sharing for the coverage of prescription insulin for diabetes at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from his or her health savings account under internal revenue service laws and regulations. The office of the insurance commissioner must provide written notice of the change in internal revenue service guidance to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office.(3) This section expires January 1, 2023.[ 2020 c 346 § 5; 2020 c 245 § 1.]NOTES:Reviser's note: This section was amended by 2020 c 245 § 1 and by 2020 c 346 § 5, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).Intent—2020 c 346: See note following RCW 70.14.165.
WA Rev Code § 48.43.785 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.785 - COVID-19 personal protective equipment expenses—Health care provider reimbursement.

RCW 48.43.785 COVID-19 personal protective equipment expenses—Health care provider reimbursement. (Contingent expiration date.)(1) For the duration of the federal public health emergency related to COVID-19, a health benefit plan shall reimburse a health care provider who bills for incurred personal protective equipment expenses as a separate expense, using the American medical association's current procedural terminology code 99072 or as subsequently amended, $6.57 for each individual patient encounter.(2) For purposes of this section, cost sharing is limited to the covered service according to the terms and conditions of the health benefit plan and does not apply to an expense for personal protective equipment.(3) This section is not intended to apply to health care services that are not provided in person.[ 2021 c 94 § 2.]NOTES:Contingent expiration date—2021 c 94 § 2: "Section 2 of this act expires upon the termination of the federal public health emergency related to COVID-19 as proclaimed by the United States department of health and human services." [ 2021 c 94 § 5.]Findings—2021 c 94: "(1) The legislature finds that:(a) The delivery of health care services is essential and maintaining patient safety during the ongoing public health emergency is paramount;(b) Pursuant to state and federal regulations, and in the interest of minimizing the risk of viral transmission, health care providers have incurred substantially increased costs during the public health emergency associated with the procurement of personal protective equipment;(c) Costs associated with providing care are typically factored into contracts between a health carrier and a health care provider, but the dramatically increased personal protective equipment costs related to the pandemic, in terms of procurement and increased "per unit" costs, were neither foreseeable nor contemplated in existing contracts; and(d) Health care providers do not want to bill patients directly for costs associated with personal protective equipment, and in many cases are precluded from doing so pursuant to terms of contract between health care providers and health carriers, so many health care providers currently do not have a mechanism to recoup costs of personal protective equipment.(2) Therefore, the legislature finds that to help ensure patient safety and continued access to personal protective equipment, it is necessary that health carriers reimburse health care providers for costs associated with personal protective equipment." [ 2021 c 94 § 1.]Application—2021 c 94: "This act applies prospectively for the duration of the state of emergency related to COVID-19." [ 2021 c 94 § 3.]Effective date—2021 c 94: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [April 16, 2021]." [ 2021 c 94 § 4.]
WA Rev Code § 48.43.790 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.790 - Behavioral services—Next-day appointments.

RCW 48.43.790 Behavioral services—Next-day appointments.Health plans issued or renewed on or after January 1, 2023, must make next-day appointments available to enrollees experiencing urgent, symptomatic behavioral health conditions to receive covered behavioral health services. The appointment may be with a licensed provider other than a licensed behavioral health professional, as long as that provider is acting within their scope of practice, and may be provided through telemedicine consistent with RCW 48.43.735. Need for urgent symptomatic care is associated with the presentation of behavioral health signs or symptoms that require immediate attention, but are not emergent.[ 2021 c 302 § 106.]NOTES:Findings—Intent—2021 c 302: See note following RCW 71.24.890.
WA Rev Code § 48.43.795 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.795 - Qualified health plans—Acceptance of premium and cost-sharing assistance.

RCW 48.43.795 Qualified health plans—Acceptance of premium and cost-sharing assistance.For qualified health plans offered on the exchange, a carrier shall:(1) Accept payments for enrollee premiums or cost-sharing assistance under RCW 43.71.110 or as part of a sponsorship program under RCW 43.71.030(4). Nothing in this subsection expands or restricts the types of sponsorship programs authorized under state and federal law;(2) Clearly communicate premium assistance amounts to enrollees as part of the invoicing and payment process; and(3) Accept and process enrollment and payment data transferred by the exchange in a timely manner.[ 2021 c 246 § 4.]
WA Rev Code § 48.43.300 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.300 - Definitions.

RCW 48.43.300 Definitions.The definitions in this section apply throughout RCW 48.43.300 through 48.43.370 unless the context clearly requires otherwise.(1) "Adjusted RBC report" means an RBC report that has been adjusted by the commissioner in accordance with RCW 48.43.305(4).(2) "Corrective order" means an order issued by the commissioner specifying corrective actions that the commissioner has determined are required.(3) "Domestic carrier" means any carrier domiciled in this state, or any person or entity subject to chapter 48.42 RCW domiciled in this state.(4) "Foreign or alien carrier" means any carrier that is licensed to do business in this state but is not domiciled in this state, or any person or entity subject to chapter 48.42 RCW not domiciled in this state.(5) "NAIC" means the national association of insurance commissioners.(6) "Negative trend" means, with respect to a carrier, a negative trend over a period of time, as determined in accordance with the "trend test calculation" included in the RBC instructions.(7) "RBC" means risk-based capital.(8) "RBC instructions" means the RBC report including risk-based capital instructions adopted by the NAIC, as such RBC instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC.(9) "RBC level" means a carrier's company action level RBC, regulatory action level RBC, authorized control level RBC, or mandatory control level RBC where:(a) "Company action level RBC" means, with respect to any carrier, the product of 2.0 and its authorized control level RBC;(b) "Regulatory action level RBC" means the product of 1.5 and its authorized control level RBC;(c) "Authorized control level RBC" means the number determined under the risk-based capital formula in accordance with the RBC instructions;(d) "Mandatory control level RBC" means the product of .70 and the authorized control level RBC.(10) "RBC plan" means a comprehensive financial plan containing the elements specified in RCW 48.43.310(2). If the commissioner rejects the RBC plan, and it is revised by the carrier, with or without the commissioner's recommendation, the plan shall be called the "revised RBC plan."(11) "RBC report" means the report required in RCW 48.43.305.(12) "Total adjusted capital" means the sum of:(a) Either a carrier's statutory capital and surplus or net worth, or both, as determined in accordance with statutory accounting applicable to the annual financial statements required to be filed with the commissioner; and(b) Other items, if any, as the RBC instructions may provide.[ 1998 c 241 § 1.]
WA Rev Code § 48.43.305 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.305 - Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.

RCW 48.43.305 Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.(1) Every domestic carrier shall, on or prior to the filing date of March 1st, prepare and submit to the commissioner a report of its RBC levels as of the end of the calendar year just ended, in a form and containing such information as is required by the RBC instructions. In addition, every domestic carrier shall file its RBC report:(a) With the NAIC in accordance with the RBC instructions; and(b) With the insurance commissioner in any state in which the carrier is authorized to do business, if the insurance commissioner has notified the carrier of its request in writing, in which case the carrier shall file its RBC report not later than the later of:(i) Fifteen days from the receipt of notice to file its RBC report with that state; or(ii) The filing date.(2) A carrier's RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account (and may adjust for the covariance between):(a) The risk with respect to the carrier's assets;(b) The risk of adverse insurance experience with respect to the carrier's liabilities and obligations;(c) The interest rate risk with respect to the carrier's business; and(d) All other business risks and such other relevant risks as are set forth in the RBC instructions; determined in each case by applying the factors in the manner set forth in the RBC instructions.(3) An excess of capital over the amount produced by the risk-based capital requirements contained in RCW 48.43.300 through 48.43.370 and the formulas, schedules, and instructions referenced in RCW 48.43.300 through 48.43.370 is desirable in the business of insurance. Accordingly, carriers should seek to maintain capital above the RBC levels required by RCW 48.43.300 through 48.43.370. Additional capital is used and useful in the insurance business and helps to secure a carrier against various risks inherent in, or affecting, the business of insurance and not accounted for or only partially measured by the risk-based capital requirements contained in RCW 48.43.300 through 48.43.370.(4) If a domestic carrier files an RBC report that in the judgment of the commissioner is inaccurate, then the commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the carrier of the adjustment. The notice shall contain a statement of the reason for the adjustment.[ 1998 c 241 § 2.]