reglab/housing_qa huggingface dataset:
WA Rev Code § 48.43.055 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.055 - Procedures for review and adjudication of health care provider complaints—Requirements.

RCW 48.43.055 Procedures for review and adjudication of health care provider complaints—Requirements.(1) Except as provided by subsection (2) of this section, each health carrier as defined under RCW 48.43.005 shall file with the commissioner its procedures for review and adjudication of complaints initiated by health care providers. Procedures filed under this section shall provide a fair review for consideration of complaints. Every health carrier shall provide reasonable means allowing any health care provider aggrieved by actions of the health carrier to be heard after submitting a written request for review. If the health carrier fails to grant or reject a request within thirty days after it is made, the complaining health care provider may proceed as if the complaint had been rejected. A complaint that has been rejected by the health carrier may be submitted to nonbinding mediation. Mediation shall be conducted under chapter 7.07 RCW, or any other rules of mediation agreed to by the parties. This section is solely for resolution of provider complaints. Complaints by, or on behalf of, a covered person are subject to the grievance processes in RCW 48.43.530.(2) For purposes of out-of-network payment disputes between a health carrier and health care provider covered under the provisions of chapter 48.49 RCW, the arbitration provisions of chapter 48.49 RCW apply.[ 2019 c 427 § 28; 2005 c 172 § 19; 2002 c 300 § 6; 1995 c 265 § 20.]NOTES:Findings—Intent—Effective date—2019 c 427: See RCW 48.49.003 and 48.49.900.Short title—Effective date—2005 c 172: See RCW 7.07.900 and 7.07.904.Captions not law—Effective dates—Savings—Severability—1995 c 265: See notes following RCW 70.47.015.
WA Rev Code § 48.43.059 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.059 - Payments made by a second-party payment process—Definition.

RCW 48.43.059 Payments made by a second-party payment process—Definition.(1) For the purposes of this section, "second-party payment process" means a process in which: (a) An individual has an account under his or her name maintained with a financial institution and is either managed by the financial institution or an entity that, with the express agreement with the individual, has established the account on behalf of the individual with a financial institution; (b) the account is funded with funds from the individual or his or her family members or in a manner otherwise consistent with federal law including, but not limited to, federal guidance implementing the federal patient protection and affordable care act; and (c) the account is under the control of the covered person, such that the covered person may authorize payments from the account.(2) All issuers must accept any payments made by a second-party payment process; however, no issuer need accept payment by a second-party payment process if the second-party payer is controlled by or receives funding from any entity where such entity may be reimbursed by an issuer for providing health care services or if the account under the control of the covered person is funded by any such entity, except those third-party entities from whom federal law requires such issuer to accept payment.(3) Payments made under subsection (2) of this section may be made with any legal tender denominated in United States dollars.[ 2015 c 284 § 2.]NOTES:Recognition—Intent—2015 c 284: "(1) The legislature recognizes that under regulations implementing the federal patient protection and affordable care act, issuers offering individual market qualified health plans are required to accept third-party premium and cost-sharing payments from the Ryan White HIV/AIDS program under Title XXVI of the public health service act, Indian tribes, tribal organizations or urban Indian organizations, and state and federal government programs. However, federal regulators have stated that they have serious concerns about payments made on a third-party basis by hospitals, health care providers, and other commercial entities using their own funds because of the potential that such payments could cause distortions in the insurance market.(2) The legislature intends to clarify that an entity that makes premium payments from accounts that are owned and controlled by the covered person do not constitute a third party for the purposes of acceptance of premium payments by an issuer. The legislature does not intend to impact third-party payment programs required under federal law , including, but not limited to, federal guidance implementing the federal patient protection and affordable care act." [ 2015 c 284 § 1.]
WA Rev Code § 48.43.071 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.071 - Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.

RCW 48.43.071 Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.Upon request of a covered person or a covered person's personal representative, an issuer shall provide the covered person or representative with one copy of the covered person's health care information free of charge if the covered person is appealing the denial of federal supplemental security income or social security disability benefits. The issuer may provide the health care information in either paper or electronic format. An issuer is not required to provide a covered person or a covered person's personal representative with a free copy of health care information that has previously been provided free of charge pursuant to a request within the preceding two years. For purposes of this section, "health care information" has the same meaning as in RCW 70.02.010.[ 2018 c 87 § 4.]
WA Rev Code § 48.43.073 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.073 - Required abortion coverage—Limitations.

RCW 48.43.073 Required abortion coverage—Limitations.(1) Except as provided in subsection (5) of this section, if a health plan issued or renewed on or after January 1, 2019, provides coverage for maternity care or services, the health plan must also provide a covered person with substantially equivalent coverage to permit the abortion of a pregnancy. Except as provided in subsection (5) of this section, if a student health plan, including student health plans deemed by the insurance commissioner to have a short-term limited purpose or duration or to be guaranteed renewable while the covered person is enrolled as a regular full-time undergraduate or graduate student at an accredited higher education institution, issued or renewed on or after January 1, 2022, provides coverage for maternity care or services, the health plan must also provide a covered person with substantially equivalent coverage to permit the abortion of a pregnancy.(2)(a) Except as provided in (b) of this subsection, a health plan or student health plan subject to subsection (1) of this section may not limit in any way a person's access to services related to the abortion of a pregnancy.(b)(i) Coverage for the abortion of a pregnancy may be subject to terms and conditions generally applicable to the health plan or student health plan's coverage of maternity care or services, including applicable cost sharing.(ii) A health plan or student health plan is not required to cover abortions that would be unlawful under RCW 9.02.120.(3) Nothing in this section may be interpreted to limit in any way an individual's constitutionally or statutorily protected right to voluntarily terminate a pregnancy.(4) This section does not, pursuant to 42 U.S.C. Sec. 18054(a)(6), apply to a multistate plan that does not provide coverage for the abortion of a pregnancy.(5) If the application of this section to a health plan or student health plan results in noncompliance with federal requirements that are a prescribed condition to the allocation of federal funds to the state, this section is inapplicable to the plan to the minimum extent necessary for the state to be in compliance. The inapplicability of this section to a specific health plan or student health plan under this subsection does not affect the operation of this section in other circumstances.[ 2021 c 53 § 1; 2018 c 119 § 3.]NOTES:Findings—Declarations—2018 c 119: See note following RCW 48.43.072.
WA Rev Code § 48.43.074 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.074 - Qualified health plans—Single invoice billing—Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.

RCW 48.43.074 Qualified health plans—Single invoice billing—Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.(1) The legislature intends to codify the state's current practice of requiring health carriers to bill enrollees with a single invoice and to segregate into a separate account the premium attributable to abortion services for which federal funding is prohibited. Washington has achieved full compliance with section 1303 of the federal patient protection and affordable care act by requiring health carriers to submit a single invoice to enrollees and to segregate into a separate account the premium amounts attributable to coverage of abortion services for which federal funding is prohibited. Further, section 1303 states that the act does not preempt or otherwise have any effect on state laws regarding the prohibition of, or requirement of, coverage, funding, or procedural requirements on abortions.(2) In accordance with RCW 48.43.073 related to requirements for coverage and funding of abortion services, an issuer offering a qualified health plan must:(a) Bill enrollees and collect payment through a single invoice that includes all benefits and services covered by the qualified health plan; and(b) Include in the segregation plan required under applicable federal and state law a certification that the issuer's billing and payment processes meet the requirements of this section.[ 2019 c 399 § 5.]NOTES:Effective date—2019 c 399 § 5: "Section 5 of 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 [May 13, 2019]." [ 2019 c 399 § 10.]Findings—Short title—2019 c 399: See notes following RCW 74.09.875.Recommendations—Preexposure and postexposure prophylaxis financial support awareness—2019 c 399: See note following RCW 48.43.072.
WA Rev Code § 48.43.078 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.078 - Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.

RCW 48.43.078 Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.(1) Digital breast tomosynthesis, also called three-dimensional mammography, is the latest advancement in breast imaging. Studies indicate that digital breast tomosynthesis can result in a forty-one percent increase in invasive cancer detection, a fifteen percent decrease in the recall rate from screening mammography, and a twenty-nine percent increase in the detection of all breast cancers. In addition, the American college of radiology has indicated that tomosynthesis is no longer investigational. Therefore, it is the intent of the legislature to ensure women have access to the most effective breast imaging and to clarify that the existing mandate for mammography must include tomosynthesis.(2) The legislature directs the office of the insurance commissioner to clarify that the existing mandates for mammography in RCW 48.20.393, 48.21.225, 48.44.325, and 48.46.275 include coverage for tomosynthesis under the same terms and conditions currently allowed for mammography. The application of a deductible and cost sharing is prohibited, consistent with 42 U.S.C. Sec. 300-gg-13.(3) The legislature also directs the health care authority to clarify that the existing mandate for mammography in RCW 41.05.180 includes coverage for tomosynthesis under the same terms and conditions currently allowed for mammography. The application of a deductible and cost sharing is prohibited, consistent with 42 U.S.C. Sec. 300-gg-13.[ 2018 c 115 § 1.]
WA Rev Code § 48.43.083 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.083 - Chiropractor services—Participating provider agreement—Health carrier reimbursement.

RCW 48.43.083 Chiropractor services—Participating provider agreement—Health carrier reimbursement.(1) A health carrier must reimburse a chiropractor who has signed a participating provider agreement for services determined by the carrier to be medically necessary if:(a) The service is:(i) Covered chiropractic health care, as defined in RCW 48.43.515, by the health plan under which the enrollee received the services; and(ii) Provided by the chiropractor, or the chiropractor's employee specified in RCW 18.25.190 (2) or (3) who works in the same location as the chiropractor and to whom the chiropractor, pursuant to rules adopted by the Washington state chiropractic quality assurance commission, has delegated the service. The employee must meet the health carrier's reasonable qualifications for all such providers in the relevant class, including but not limited to standards for education and background checks, as applicable; and(b) The chiropractor complies with the terms and conditions of the participating provider agreement. Violations of the participating provider agreement by an employee of the chiropractor to whom he or she has delegated a service may be deemed by the carrier to have been committed by the chiropractor.(2) If a health carrier offers a participating provider agreement to a chiropractor within a single practice organized as a sole proprietorship, partnership, or corporation, the carrier must offer the same participating provider agreement to any other chiropractor within that practice providing services at the same location. The agreement may allow either party to terminate it without cause.[ 2007 c 502 § 1.]NOTES:Savings—2007 c 502: "This act does not affect any existing right acquired or liability or obligation incurred prior to January 1, 2008." [ 2007 c 502 § 3.]Severability—2007 c 502: "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." [ 2007 c 502 § 4.]Effective date—2007 c 502: "This act takes effect January 1, 2008." [ 2007 c 502 § 5.]
WA Rev Code § 48.43.085 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.085 - Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.

RCW 48.43.085 Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.Notwithstanding any other provision of law, no health carrier subject to the jurisdiction of the state of Washington may prohibit directly or indirectly its enrollees from freely contracting at any time to obtain any health care services outside the health care plan on any terms or conditions the enrollees choose. Nothing in this section shall be construed to bind a carrier for any services delivered outside the health plan. The provisions of this section shall be disclosed pursuant to *RCW 48.43.095(2). The insurance commissioner is prohibited from adopting rules regarding this section.[ 1996 c 312 § 3.]NOTES:*Reviser's note: RCW 48.43.095 was repealed by 2000 c 5 § 29, effective July 1, 2001.
WA Rev Code § 48.43.087 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.087 - Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.

RCW 48.43.087 Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.(1) For purposes of this section:(a) "Health carrier" includes disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, plans operating under the health care authority under chapter 41.05 RCW, the basic health plan operating under chapter 70.47 RCW, the state health insurance pool operating under chapter 48.41 RCW, insuring entities regulated under this chapter, and health maintenance organizations regulated under chapter 48.46 RCW.(b) "Intermediary" means a person duly authorized to negotiate and execute provider contracts with health carriers on behalf of mental health care practitioners.(c) Consistent with their lawful scopes of practice, "mental health care practitioners" includes only the following: Any generally recognized medical specialty of practitioners licensed under chapter 18.57 or 18.71 RCW who provide mental health services, advanced practice psychiatric nurses as authorized by the nursing care quality assurance commission under chapter 18.79 RCW, psychologists licensed under chapter 18.83 RCW, and mental health counselors, marriage and family therapists, and social workers licensed under chapter 18.225 RCW.(d) "Mental health services" means outpatient services.(2) Consistent with federal and state law and rule, no contract between a mental health care practitioner and an intermediary or between a mental health care practitioner and a health carrier that is written, amended, or renewed after June 6, 1996, may contain a provision prohibiting a practitioner and an enrollee from agreeing to contract for services solely at the expense of the enrollee as follows:(a) On the exhaustion of the enrollee's mental health care coverage;(b) During an appeal or an adverse certification process;(c) When an enrollee's condition is excluded from coverage; or(d) For any other clinically appropriate reason at any time.(3) If a mental health care practitioner provides services to an enrollee during an appeal or adverse certification process, the practitioner must provide to the enrollee written notification that the enrollee is responsible for payment of these services, unless the health carrier elects to pay for services provided.(4) This section does not apply to a mental health care practitioner who is employed full time on the staff of a health carrier.[ 2001 c 251 § 33; 1996 c 304 § 1.]NOTES:Severability—2001 c 251: See RCW 18.225.900.
WA Rev Code § 48.43.091 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.091 - Health carrier coverage of outpatient mental health services—Requirements.

RCW 48.43.091 Health carrier coverage of outpatient mental health services—Requirements.Every health carrier that provides coverage for any outpatient mental health service shall comply with the following requirements:(1) In performing a utilization review of mental health services for a specific enrollee, the utilization review is limited to accessing only the specific health care information contained in the enrollee's record.(2) In performing an audit of a provider that has furnished mental health services to a carrier's enrollees, the audit is limited to accessing only the records of enrollees covered by the specific health carrier for which the audit is being performed, except as otherwise permitted by RCW 70.02.050 and * 71.05.630.[ 1999 c 87 § 1.]NOTES:*Reviser's note: RCW 71.05.630 was repealed by 2013 c 200 § 34, effective July 1, 2014.
WA Rev Code § 48.43.096 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.096 - Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.

RCW 48.43.096 Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.(1) A health benefit plan issued or renewed after December 31, 2015, that provides coverage for prescription drugs must implement a medication synchronization policy for the dispensing of prescription drugs to the plan's enrollees.(a) If an enrollee requests medication synchronization for a new prescription, the health plan must permit filling the drug: (i) For less than a one-month supply of the drug if synchronization will require more than a fifteen-day supply of the drug; or (ii) for more than a one-month supply of the drug if synchronization will require a fifteen-day supply of the drug or less.(b) The health benefit plan shall adjust the enrollee cost-sharing for a prescription drug subject to coinsurance that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications.(c) The health benefit plan shall adjust the enrollee cost-sharing for a prescription drug with a copayment that is dispensed for less than the standard refill amount for the purpose of synchronizing the medications by:(i) Discounting the copayment rate by fifty percent;(ii) Discounting the copayment rate based on fifteen-day increments; or(iii) Any other method that meets the intent of this section and is approved by the office of the insurance commissioner.(2) Upon request of an enrollee, the prescribing provider or pharmacist shall:(a) Determine that filling or refilling the prescription is in the best interest of the enrollee, taking into account the appropriateness of synchronization for the drug being dispensed;(b) Inform the enrollee that the prescription will be filled to less than the standard refill amount for the purpose of synchronizing his or her medications; and(c) Deny synchronization on the grounds of threat to patient safety or suspected fraud or abuse.(3) For purposes of this section, the following terms have the following meanings unless the context clearly requires otherwise:(a) "Medication synchronization" means the coordination of medication refills for a patient taking two or more medications for a chronic condition such that the patient's medications are refilled on the same schedule for a given time period. (b) "Prescription" has the same meaning as in RCW 18.64.011.[ 2015 c 213 § 1.]
WA Rev Code § 48.43.097 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.097 - Filing of financial statements—Every health carrier.

RCW 48.43.097 Filing of financial statements—Every health carrier.Every health carrier holding a registration from the commissioner shall file its financial statements as required by this code and by the commissioner in accordance with the accounting practices and procedures manuals as adopted by the national association of insurance commissioners, unless otherwise provided by law.[ 1999 c 33 § 3.]