reglab/housing_qa huggingface dataset:
WA Rev Code § 48.43.320 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.320 - Authorized control level event—Commissioner's options.

RCW 48.43.320 Authorized control level event—Commissioner's options.(1) "Authorized control level event" means any of the following events:(a) The filing of an RBC report by the carrier which indicates that the carrier's total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;(b) The notification by the commissioner to the carrier of an adjusted RBC report that indicates the event in (a) of this subsection, provided the carrier does not challenge the adjusted RBC report under RCW 48.43.330;(c) If, under RCW 48.43.330, the carrier challenges an adjusted RBC report that indicates the event in (a) of this subsection, notification by the commissioner to the carrier that the commissioner has, after a hearing, rejected the carrier's challenge;(d) The failure of the carrier to respond, in a manner satisfactory to the commissioner, to a corrective order, provided the carrier has not challenged the corrective order under RCW 48.43.330; or(e) If the carrier has challenged a corrective order under RCW 48.43.330 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the carrier to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.(2) In the event of an authorized control level event with respect to a carrier, the commissioner shall:(a) Take those actions required under RCW 48.43.315 regarding a carrier with respect to which a regulatory action level event has occurred; or(b) If the commissioner deems it to be in the best interests of either the policyholders or subscribers, or both, and creditors of the carrier and of the public, take those actions necessary to cause the carrier to be placed under regulatory control under chapter 48.31 RCW. In the event the commissioner takes such actions, the authorized control level event is sufficient grounds for the commissioner to take action under chapter 48.31 RCW, and the commissioner shall have the rights, powers, and duties with respect to the carrier as are set forth in chapter 48.31 RCW. In the event the commissioner takes actions under this subsection (2)(b) pursuant to an adjusted RBC report, the carrier is entitled to those protections afforded to carriers under the provisions of RCW 48.31.121 pertaining to summary proceedings.[ 1998 c 241 § 5.]
WA Rev Code § 48.43.325 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.325 - Mandatory control level event—Commissioner's duty—Regulatory control.

RCW 48.43.325 Mandatory control level event—Commissioner's duty—Regulatory control.(1) "Mandatory control level event" means any of the following events:(a) The filing of an RBC report which indicates that the carrier's total adjusted capital is less than its mandatory control level RBC;(b) Notification by the commissioner to the carrier of an adjusted RBC report that indicates the event in (a) of this subsection, provided the carrier does not challenge the adjusted RBC report under RCW 48.43.330; or(c) If, under RCW 48.43.330, the carrier challenges an adjusted RBC report that indicates the event in (a) of this subsection, notification by the commissioner to the carrier that the commissioner has, after a hearing, rejected the carrier's challenge.(2) In the event of a mandatory control level event, with respect to a carrier, the commissioner shall take those actions necessary to place the carrier under regulatory control under chapter 48.31 RCW. In that event, the mandatory control level event is sufficient grounds for the commissioner to take action under chapter 48.31 RCW, and the commissioner shall have the rights, powers, and duties with respect to the carrier as are set forth in chapter 48.31 RCW. If the commissioner takes actions pursuant to an adjusted RBC report, the carrier is entitled to the protections of RCW 48.31.121 pertaining to summary proceedings. However, the commissioner may forego action for up to ninety days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the ninety-day period.[ 1998 c 241 § 6.]
WA Rev Code § 48.43.330 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.330 - Carrier's right to hearing—Request by carrier—Date set by commissioner.

RCW 48.43.330 Carrier's right to hearing—Request by carrier—Date set by commissioner.(1) Upon notification to a carrier by the commissioner of any of the following, the carrier shall have the right to a hearing, in accordance with chapters 48.04 and 34.05 RCW, at which the carrier may challenge any determination or action by the commissioner:(a) Of an adjusted RBC report; or(b)(i) That the carrier's RBC plan or revised RBC plan is unsatisfactory; and(ii) The notification constitutes a regulatory action level event with respect to such carrier; or(c) That the carrier has failed to adhere to its RBC plan or revised RBC plan and that such failure has a substantial adverse effect on the ability of the carrier to eliminate the company action level event with respect to the carrier in accordance with its RBC plan or revised RBC plan; or(d) Of a corrective order with respect to the carrier.(2) The carrier shall notify the commissioner of its request for a hearing within five days after the notification by the commissioner under this section. Upon receipt of the carrier's request for a hearing, the commissioner shall set a date for the hearing. The date shall be no less than ten nor more than thirty days after the date of the carrier's request.[ 1998 c 241 § 7.]
WA Rev Code § 48.43.340 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.340 - Powers or duties of commissioner not limited—Rules.

RCW 48.43.340 Powers or duties of commissioner not limited—Rules.(1) The provisions of RCW 48.43.300 through 48.43.370 are supplemental to any other provisions of the laws and rules of this state, and shall not preclude or limit any other powers or duties of the commissioner under such laws and rules, including, but not limited to, chapter 48.31 RCW.(2) The commissioner may adopt reasonable rules necessary for the implementation of RCW 48.43.300 through 48.43.370.[ 1998 c 241 § 9.]
WA Rev Code § 48.43.345 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.345 - Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.

RCW 48.43.345 Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.(1) Any foreign or alien carrier shall, upon the written request of the commissioner, submit to the commissioner an RBC report as of the end of the calendar year just ended by the later of:(a) The date an RBC report would be required to be filed by a domestic carrier under RCW 48.43.300 through 48.43.370; or(b) Fifteen days after the request is received by the foreign or alien carrier. Any foreign or alien carrier shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.(2) In the event of a company action level event, regulatory action level event, or authorized control level event with respect to any foreign or alien carrier as determined under the RBC statute applicable in the state of domicile of the carrier or, if no RBC statute is in force in that state, under the provisions of RCW 48.43.300 through 48.43.370, if the insurance commissioner of the state of domicile of the foreign or alien carrier fails to require the foreign or alien carrier to file an RBC plan in the manner specified under that state's RBC statute or, if no RBC statute is in force in that state, under RCW 48.43.310, the commissioner may require the foreign or alien carrier to file an RBC plan with the commissioner. In this event, the failure of the foreign or alien carrier to file an RBC plan with the commissioner is grounds to order the carrier to cease and desist from writing new insurance business in this state.(3) In the event of a mandatory control level event with respect to any foreign or alien carrier, if no domiciliary receiver has been appointed with respect to the foreign or alien carrier under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign or alien carrier, the commissioner may apply for an order under RCW 48.31.080 or 48.31.090 to conserve the assets within this state of foreign or alien carriers, and the occurrence of the mandatory control level event is considered adequate grounds for the application.[ 1998 c 241 § 10.]
WA Rev Code § 48.43.350 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.350 - No liability or cause of action against commissioner or department.

RCW 48.43.350 No liability or cause of action against commissioner or department.There is no liability on the part of, and no cause of action shall arise against, the commissioner or insurance department or its employees or agents for any action taken by them in the performance of their powers and duties under RCW 48.43.300 through 48.43.370.[ 1998 c 241 § 11.]
WA Rev Code § 48.43.355 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.355 - Notice by commissioner to carrier—When effective.

RCW 48.43.355 Notice by commissioner to carrier—When effective.All notices by the commissioner to a carrier that may result in regulatory action are effective upon dispatch if transmitted by registered or certified mail, or in the case of any other transmission, are effective upon the carrier's receipt of such notice.[ 1998 c 241 § 12.]
WA Rev Code § 48.43.360 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.360 - Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.

RCW 48.43.360 Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.For RBC reports to be filed by carriers commencing operations after June 11, 1998, those carriers shall calculate the initial RBC levels using financial projections, considering managed care arrangements, for its first full year in operation. Such projections, including the risk-based capital requirement, must be included as part of a comprehensive business plan that is submitted as part of the application for registration under RCW 48.44.040 and 48.46.030. The resulting RBC requirement shall be reported in the first RBC report submitted under RCW 48.43.305. For subsequent reports, the RBC results using actual financial data shall be included.[ 1998 c 241 § 13.]
WA Rev Code § 48.43.366 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.366 - Self-funded multiple employer welfare arrangements.

RCW 48.43.366 Self-funded multiple employer welfare arrangements.A self-funded multiple employer welfare arrangement, as defined in RCW 48.125.010, is subject to the same RBC reporting requirements as a domestic carrier under RCW 48.43.300 through 48.43.370.[ 2004 c 260 § 19.]NOTES:Effective date—2004 c 260: See RCW 48.125.901.
WA Rev Code § 48.43.370 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.370 - RBC standards not applicable to certain carriers.

RCW 48.43.370 RBC standards not applicable to certain carriers.RCW 48.43.300 through 48.43.370 shall not apply to a carrier which is subject to the provisions of RCW 48.05.430 through * 48.05.490.[ 1998 c 241 § 15.]NOTES:*Reviser's note: RCW 48.05.490 was repealed by 2006 c 25 § 11.
WA Rev Code § 48.43.400 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.400 - Prescription drug utilization management—Definitions.

RCW 48.43.400 Prescription drug utilization management—Definitions.The definitions in this section apply throughout this section and RCW 48.43.410 and 48.43.420 unless the context clearly requires otherwise.(1) "Clinical practice guidelines" means a systemically developed statement to assist decision making by health care providers and patients about appropriate health care for specific clinical circumstances and conditions.(2) "Clinical review criteria" means the written screening procedures, decision rules, medical protocols, and clinical practice guidelines used by a health carrier or prescription drug utilization management entity as an element in the evaluation of medical necessity and appropriateness of requested prescription drugs under a health plan.(3) "Emergency fill" means a limited dispensed amount of medication that allows time for the processing of prescription drug utilization management.(4) "Medically appropriate" means prescription drugs that under the applicable standard of care are appropriate: (a) To improve or preserve health, life, or function; (b) to slow the deterioration of health, life, or function; or (c) for the early screening, prevention, evaluation, diagnosis, or treatment of a disease, condition, illness, or injury.(5) "Prescription drug utilization management" means a set of formal techniques used by a health carrier or prescription drug utilization management entity, that are designed to monitor the use of or evaluate the medical necessity, appropriateness, efficacy, or efficiency of prescription drugs including, but not limited to, prior authorization and step therapy protocols.(6) "Prescription drug utilization management entity" means an entity affiliated with, under contract with, or acting on behalf of a health carrier to perform prescription drug utilization management.(7) "Prior authorization" means a mandatory process that a carrier or prescription drug utilization management entity requires a provider or facility to follow to determine if a service is a benefit and meets the requirements for medical necessity, clinical appropriateness, level of care, or effectiveness in relation to the applicable plan.(8) "Step therapy protocol" means a protocol or program that establishes the specific sequence in which prescription drugs for a specified medical condition will be covered by a health carrier.[ 2019 c 171 § 1.]NOTES:Rules—2019 c 171: See note following RCW 48.43.420.
WA Rev Code § 48.43.410 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.410 - Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.

RCW 48.43.410 Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.For health plans delivered, issued for delivery, or renewed on or after January 1, 2021, clinical review criteria used to establish a prescription drug utilization management protocol must be evidence-based and updated on a regular basis through review of new evidence, research, and newly developed treatments.[ 2019 c 171 § 2.]NOTES:Rules—2019 c 171: See note following RCW 48.43.420.
WA Rev Code § 48.43.430 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.430 - Prescription medication—Maximum charge at point of sale—Requirements.

RCW 48.43.430 Prescription medication—Maximum charge at point of sale—Requirements.(1) Beginning January 1, 2021, the maximum amount a health carrier or pharmacy benefit manager may require a person to pay at the point of sale for a covered prescription medication is the lesser of:(a) The applicable cost sharing for the prescription medication; or(b) The amount the person would pay for the prescription medication if the person purchased the prescription medication without using a health plan.(2) A health carrier or pharmacy benefit manager may not require a pharmacist to dispense a brand name prescription medication when a less expensive therapeutically equivalent generic prescription medication is available.(3) For purposes of this section, "pharmacy benefit manager" has the same meaning as in *RCW 19.340.010.[ 2020 c 116 § 1.]NOTES:*Reviser's note: RCW 19.340.010 was repealed by 2020 c 240 § 19, effective January 1, 2022. For later enactment, see RCW 48.200.020.
WA Rev Code § 48.43.500 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.500 - Intent—Purpose—2000 c 5.

RCW 48.43.500 Intent—Purpose—2000 c 5.It is the intent of the legislature that enrollees covered by health plans receive quality health care designed to maintain and improve their health. The purpose of chapter 5, Laws of 2000 is to ensure that health plan enrollees:(1) Have improved access to information regarding their health plans;(2) Have sufficient and timely access to appropriate health care services, and choice among health care providers;(3) Are assured that health care decisions are made by appropriate medical personnel;(4) Have access to a quick and impartial process for appealing plan decisions;(5) Are protected from unnecessary invasions of health care privacy; and(6) Are assured that personal health care information will be used only as necessary to obtain and pay for health care or to improve the quality of care.[ 2000 c 5 § 1.]NOTES:Application—2000 c 5: "This act applies to: Health plans as defined in RCW 48.43.005 offered, renewed, or issued by a carrier; medical assistance provided under RCW 74.09.522; the basic health plan offered under chapter 70.47 RCW; and health benefits provided under chapter 41.05 RCW." [ 2000 c 5 § 19.]Short title—2000 c 5: "This act may be known and cited as the health care patient bill of rights." [ 2000 c 5 § 22.]Captions not law—2000 c 5: "Captions used in this act are not any part of the law." [ 2000 c 5 § 24.]Construction—2000 c 5: "To the extent permitted by law, if any provision of this act conflicts with state or federal law, such provision must be construed in a manner most favorable to the enrollee." [ 2000 c 5 § 26.]Severability—2000 c 5: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 2000 c 5 § 27.]Application to contracts—Effective dates—2000 c 5: "(1) Except as provided in subsections (2) and (3) of this section, this act applies to contracts entered into or renewing after June 30, 2001.(2) Sections 13, 14, 15, and 16 of this act take effect January 1, 2001.(3) Section 29 of this act takes effect July 1, 2001." [ 2000 c 5 § 28.]
WA Rev Code § 48.43.5051 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.5051 - Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.

RCW 48.43.5051 Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.(1) The commissioner shall:(a) Develop a process for the regular collection of information from carriers on requests for confidential communications pursuant to RCW 48.43.505 for the purposes of monitoring compliance, including monitoring:(i) The effectiveness of the process described in RCW 48.43.505 in allowing protected individuals to redirect insurance communications, the extent to which protected individuals are using the process, and whether the process is working properly; and(ii) The education and outreach activities conducted by carriers to inform enrollees about their right to confidential communications;(b) Establish a process for ensuring compliance; and(c) Develop rules necessary to implement chapter 56, Laws of 2019.(2) The commissioner shall work with stakeholders to develop and make available to the public a standardized form that a protected individual may submit to a carrier to make a confidential communications request. At minimum, this form must:(a) Inform a protected individual about the protected individual's right to confidential communications;(b) Allow a protected individual to indicate where to redirect communications, including a specified physical or email address or specified telephone number; and(c) Include a disclaimer that it may take up to three business days from the date of receipt for a carrier to process the form.[ 2019 c 56 § 4.]NOTES:Findings—Declarations—2019 c 56: "The legislature finds and declares:(1) All people deserve the right to choose the health services that are right for them, and the right to confidential access to those health services.(2) When people are assured of the ability to confidentially access health care services, they are more likely to seek health services, disclose health risk behaviors to a clinician, and return for follow-up care.(3) When denied confidential access to needed care, people may delay or forgo care, leading to higher rates of unprotected sex, unintended pregnancy, untreated sexually transmitted infections, and mental health issues, or they may turn to public health safety net funds or free clinics to receive confidential care—important resources that should be reserved for people who do not have insurance coverage." [ 2019 c 56 § 1.]Effective date—2019 c 56: "This act takes effect January 1, 2020." [ 2019 c 56 § 8.]
WA Rev Code § 48.43.517 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.517 - Enrollment of child participating in medical assistance program—Employer-sponsored health plan.

RCW 48.43.517 Enrollment of child participating in medical assistance program—Employer-sponsored health plan.When the health care authority has determined that it is cost-effective to enroll a child participating in a medical assistance program under chapter 74.09 RCW in an employer-sponsored health plan, the carrier shall permit the enrollment of the participant who is otherwise eligible for coverage in the health plan without regard to any open enrollment restrictions. The request for special enrollment shall be made by the authority or participant within sixty days of the authority's determination that the enrollment would be cost-effective.[ 2011 1st sp.s. c 15 § 78; 2007 c 5 § 7.]NOTES:Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
WA Rev Code § 48.43.520 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.520 - Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.

RCW 48.43.520 Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.(1) Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review criteria based on reasonable medical evidence. The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, and other review criteria available upon request to participating providers.(2) The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.(3) A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing care.[ 2000 c 5 § 8.]NOTES:Application—Short title—Captions not law—Construction—Severability—Application to contracts—Effective dates—2000 c 5: See notes following RCW 48.43.500.