reglab/housing_qa huggingface dataset:
WA Rev Code § 48.43.105 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.105 - Preparation of documents that compare health carriers—Immunity—Due diligence.

RCW 48.43.105 Preparation of documents that compare health carriers—Immunity—Due diligence.(1) A public or private entity who exercises due diligence in preparing a document of any kind that compares health carriers of any kind is immune from civil liability from claims based on the document and the contents of the document.(2)(a) There is absolute immunity to civil liability from claims based on such a comparison document and its contents if the information was provided by the carrier, was substantially accurately presented, and contained the effective date of the information that the carrier supplied, if any.(b) Where due diligence efforts to obtain accurate information have been taken, there is immunity from claims based on such a comparison document and its contents if the publisher of the comparison document asked for such information from the carrier, was refused, and relied on any usually reliable source for the information including, but not limited to, carrier enrollees, customers, insurance producers, or providers. The carrier enrollees, customers, insurance producers, or providers are likewise immune from civil liability on claims based on information they provided if they believed the information to be accurate and had exercised due diligence in their efforts to confirm the accuracy of the information provided.(3) The immunity from liability contained in this section applies only if the comparison document contains the following in a conspicuous place and in easy to read typeface:This comparison is based on information believed to be reliable by its publisher, but the accuracy of the information cannot be guaranteed. Caution is suggested to all readers who are encouraged to confirm data of importance to the reader before any purchasing or other decisions are made.(4) The insurance commissioner is prohibited from adopting rules regarding this section.[ 2008 c 217 § 48; 1996 c 312 § 5.]NOTES:Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
WA Rev Code § 48.43.125 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.125 - Coverage at a long-term care facility following hospitalization—Definition.

RCW 48.43.125 Coverage at a long-term care facility following hospitalization—Definition.(1) A carrier that provides coverage for a person at a long-term care facility following the person's hospitalization shall, upon the request of the person or his or her legal representative as authorized in RCW 7.70.065, provide such coverage at the facility in which the person resided immediately prior to the hospitalization if:(a) The person's primary care physician determines that the medical care needs of the person can be met at the requested facility;(b) The requested facility has all applicable licenses and certifications, and is not under a stop placement order that prevents the person's readmission;(c) The requested facility agrees to accept payment from the carrier for covered services at the rate paid to similar facilities that otherwise contract with the carrier to provide such services; and(d) The requested facility, with regard to the following, agrees to abide by the standards, terms, and conditions required by the carrier of similar facilities with which the carrier otherwise contracts: (i) Utilization review, quality assurance, and peer review; and (ii) management and administrative procedures, including data and financial reporting that may be required by the carrier.(2) For purposes of this section, "long-term care facility" or "facility" means a nursing facility licensed under chapter 18.51 RCW, continuing care retirement community defined under RCW 70.38.025, or assisted living facility licensed under chapter 18.20 RCW.[ 2012 c 10 § 43; 1999 c 312 § 2.]NOTES:Application—2012 c 10: See note following RCW 18.20.010.Findings—1999 c 312: "The legislature finds that a long-term care facility is home for any individual who resides there, and the individual has the right to receive services in his or her own home and to be cared for by the organization with which he or she has a contractual agreement to provide housing and related services. The legislature further finds that restricting individuals from returning to the long-term care facility in which they were residing prior to hospitalization may detrimentally impact the health and well-being of frail individuals and their families." [ 1999 c 312 § 1.]Short title—1999 c 312: "This act may be known and cited as the Kitson act." [ 1999 c 312 § 3.]
WA Rev Code § 48.43.176 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.176 - Eosinophilic gastrointestinal associated disorder—Elemental formula.

RCW 48.43.176 Eosinophilic gastrointestinal associated disorder—Elemental formula.(1) Each health benefit plan issued or renewed after December 31, 2015, must offer benefits or coverage for medically necessary elemental formula, regardless of delivery method, when a licensed physician or other health care provider with prescriptive authority:(a) Diagnoses a patient with an eosinophilic gastrointestinal associated disorder; and(b) Orders and supervises the use of the elemental formula.(2) Nothing in this section prohibits a health benefit plan from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for medically necessary elemental formula.[ 2014 c 115 § 2.]
WA Rev Code § 48.43.180 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.180 - Denturist services.

RCW 48.43.180 Denturist services.Notwithstanding any provision of any certified health plan covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not be denied thereunder for any service performed by a denturist licensed under chapter 18.30 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such plan would have provided benefits if such service had been performed by a dentist licensed under chapter 18.32 RCW.[ 1995 c 1 § 23 (Initiative Measure No. 607, approved November 8, 1994).]NOTES:Short title—1995 c 1 (Initiative Measure No. 607): See RCW 18.30.900.
WA Rev Code § 48.43.185 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.185 - General anesthesia services for dental procedures.

RCW 48.43.185 General anesthesia services for dental procedures.(1) Each group health benefit plan that provides coverage for hospital, medical, or ambulatory surgery center services must cover general anesthesia services and related facility charges in conjunction with any dental procedure performed in a hospital or ambulatory surgical center if such anesthesia services and related facility charges are medically necessary because the covered person:(a) Is under the age of seven, or physically or developmentally disabled, with a dental condition that cannot be safely and effectively treated in a dental office; or(b) Has a medical condition that the person's physician determines would place the person at undue risk if the dental procedure were performed in a dental office. The procedure must be approved by the person's physician.(2) Each group health benefit plan or group dental plan that provides coverage for dental services must cover medically necessary general anesthesia services in conjunction with any covered dental procedure performed in a dental office if the general anesthesia services are medically necessary because the covered person is under the age of seven or physically or developmentally disabled.(3) This section does not prohibit a group health benefit plan or group dental plan from:(a) Applying cost-sharing requirements, maximum annual benefit limitations, and prior authorization requirements to the services required under this section; or(b) Covering only those services performed by a health care provider, or in a health care facility, that is part of its provider network; nor does it limit the health carrier in negotiating rates and contracts with specific providers.(4) This section does not apply to medicare supplement policies, or supplemental contracts covering a specified disease or other limited benefits.(5) For the purpose of this section, "general anesthesia services" means services to induce a state of unconsciousness accompanied by a loss of protective reflexes, including the ability to maintain an airway independently and respond purposefully to physical stimulation or verbal command.(6) This section applies to group health benefit plans and group dental plans issued or renewed on or after January 1, 2002.[ 2001 c 321 § 2.]
WA Rev Code § 48.43.190 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.190 - Payment of chiropractic services—Parity.

RCW 48.43.190 Payment of chiropractic services—Parity.(1)(a) A health carrier may not pay a chiropractor less for a service or procedure identified under a particular physical medicine and rehabilitation code, evaluation and management code, or spinal manipulation code, as listed in a nationally recognized services and procedures code book such as the American medical association current procedural terminology code book, than it pays any other type of provider licensed under Title 18 RCW for a service or procedure under the same or substantially similar code, except as provided in (b) of this subsection. A carrier may not circumvent this requirement by creating a chiropractor-specific code not listed in the nationally recognized code book otherwise used by the carrier for provider payment.(b) This section does not affect a health carrier's:(i) Implementation of a health care quality improvement program to promote cost-effective and clinically efficacious health care services, including but not limited to pay-for-performance payment methodologies and other programs fairly applied to all health care providers licensed under Title 18 RCW that are designed to promote evidence-based and research-based practices;(ii) Health care provider contracting to comply with the network adequacy standards;(iii) Authority to pay in-network providers differently than out-of-network providers; and(iv) Authority to pay a chiropractor less than another provider for procedures or services under the same or a substantially similar code based upon differences in the cost of maintaining a practice or carrying malpractice insurance, as recognized by a nationally accepted reimbursement methodology.(c) This section does not, and may not be construed to:(i) Require the payment of provider billings that do not meet the definition of a clean claim as set forth in rules adopted by the commissioner;(ii) Require any health plan to include coverage of any condition; or(iii) Expand the scope of practice for any health care provider.(2) This section applies only to payments made on or after January 1, 2009.[ 2018 c 181 § 1; 2008 c 304 § 1.]NOTES:Rules—2018 c 181 § 1: "The office of the insurance commissioner may adopt any rules necessary to implement section 1 of this act." [ 2018 c 181 § 2.]Effective date—2018 c 181 § 1: "Section 1 of this act takes effect January 1, 2019." [ 2018 c 181 § 3.]
WA Rev Code § 48.43.195 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.195 - Contraceptive drugs—Twelve-month refill coverage.

RCW 48.43.195 Contraceptive drugs—Twelve-month refill coverage.(1) A health benefit plan issued or renewed on or after January 1, 2018, that includes coverage for contraceptive drugs must provide reimbursement for a twelve-month refill of contraceptive drugs obtained at one time by the enrollee, unless the enrollee requests a smaller supply or the prescribing provider instructs that the enrollee must receive a smaller supply. The health plan must allow enrollees to receive the contraceptive drugs on-site at the provider's office, if available. Any dispensing practices required by the plan must follow clinical guidelines for appropriate prescribing and dispensing to ensure the health of the patient while maximizing access to effective contraceptive drugs.(2) Nothing in this section prohibits a health plan from limiting refills that may be obtained in the last quarter of the plan year if a twelve-month supply of the contraceptive drug has already been dispensed during the plan year.(3) For purposes of this section, "contraceptive drugs" means all drugs approved by the United States food and drug administration that are used to prevent pregnancy, including, but not limited to, hormonal drugs administered orally, transdermally, and intravaginally.[ 2017 c 293 § 2.]NOTES:Finding—Intent—2017 c 293: "The legislature finds that a significant percentage of pregnancies are unintended and could be averted with broader access to health care and effective contraception. Research suggests that moving from twenty-eight day dispensing of contraceptive drugs to twelve-month dispensing improves adherence to maintenance of the drugs and effective use of the contraceptives. It is therefore the intent of the legislature to require private health insurers to require dispensing of contraceptive drugs with up to a twelve-month supply provided at one time." [ 2017 c 293 § 1.]
WA Rev Code § 48.43.200 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.200 - Disclosure of certain material transactions—Report—Information is confidential.

RCW 48.43.200 Disclosure of certain material transactions—Report—Information is confidential.(1) Every certified health plan domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless these acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval, or information purposes under other provisions of this title or other requirements.(2) The report required in subsection (1) of this section is due within fifteen days after the end of the calendar month in which any of the transactions occur.(3) One complete copy of the report, including any exhibits or other attachments filed as part of the report, shall be filed with the:(a) Commissioner; and(b) National association of insurance commissioners.(4) All reports obtained by or disclosed to the commissioner under this section and RCW 48.43.205 through 48.43.225 are exempt from public inspection and copying and shall not be subject to subpoena. These reports shall not be made public by the commissioner, the national association of insurance commissioners, or any other person, except to insurance departments of other states, without the prior written consent of the certified health plan to which it pertains unless the commissioner, after giving the certified health plan that would be affected by disclosure notice and a hearing under chapter 48.04 RCW, determines that the interest of policyholders, subscribers, shareholders, or the public will be served by the publication, in which event the commissioner may publish all or any part of the report in the manner he or she deems appropriate.[ 1995 c 86 § 7.]
WA Rev Code § 48.43.205 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.205 - Material acquisitions or dispositions.

RCW 48.43.205 Material acquisitions or dispositions.No acquisitions or dispositions of assets need be reported pursuant to RCW 48.43.200 if the acquisitions or dispositions are not material. For purposes of RCW 48.43.200 through 48.43.225, a material acquisition, or the aggregate of any series of related acquisitions during any thirty-day period; or disposition, or the aggregate of any series of related dispositions during any thirty-day period is an acquisition or disposition that is nonrecurring and not in the ordinary course of business and involves more than five percent of the reporting certified health plan's total assets as reported in its most recent statutory statement filed with the commissioner.[ 1995 c 86 § 8.]
WA Rev Code § 48.43.210 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.210 - Asset acquisitions—Asset dispositions.

RCW 48.43.210 Asset acquisitions—Asset dispositions.(1) Asset acquisitions subject to RCW 48.43.200 through 48.43.225 include every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting certified health plan or the acquisition of materials for such purpose.(2) Asset dispositions subject to RCW 48.43.200 through 48.43.225 include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, abandonment, destruction, other disposition, or assignment, whether for the benefit of creditors or otherwise.[ 1995 c 86 § 9.]
WA Rev Code § 48.43.215 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.215 - Report of a material acquisition or disposition of assets—Information required.

RCW 48.43.215 Report of a material acquisition or disposition of assets—Information required.(1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets:(a) Date of the transaction;(b) Manner of acquisition or disposition;(c) Description of the assets involved;(d) Nature and amount of the consideration given or received;(e) Purpose of or reason for the transaction;(f) Manner by which the amount of consideration was determined;(g) Gain or loss recognized or realized as a result of the transaction; and(h) Names of the persons from whom the assets were acquired or to whom they were disposed.(2) Certified health plans are required to report material acquisitions and dispositions on a nonconsolidated basis unless the certified health plan is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent reinsurance agreement that affects the solvency and integrity of the certified health plan's reserves and such certified health plan ceded substantially all of its direct and assumed business to the pool. A certified health plan has ceded substantially all of its direct and assumed business to a pool if the certified health plan has less than one million dollars total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent of the certified health plan's net worth.[ 1995 c 86 § 10.]
WA Rev Code § 48.43.220 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.220 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

RCW 48.43.220 Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.43.200 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.43.200 through 48.43.225, a material nonrenewal, cancellation, or revision is one that affects:(a) More than fifty percent of a certified health plan's total reserve credit taken for business ceded, on an annualized basis, as indicated in the certified health plan's most recent annual statement;(b) More than ten percent of a certified health plan's total cession when it is replaced by one or more unauthorized reinsurers; or(c) Previously established collateral requirements, when they have been reduced or waived as respects one or more unauthorized reinsurers representing collectively more than ten percent of a total cession.(2) However, a filing is not required if the certified health plan's total reserve credit taken for business ceded represents, on an annualized basis, less than ten percent of the statutory reserve requirement prior to any cession.[ 1995 c 86 § 11.]
WA Rev Code § 48.43.225 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.225 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

RCW 48.43.225 Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.(1) The following is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements:(a) The effective date of the nonrenewal, cancellation, or revision;(b) The description of the transaction with an identification of the initiator;(c) The purpose of or reason for the transaction; and(d) If applicable, the identity of the replacement reinsurers.(2) Certified health plans are required to report all material nonrenewals, cancellations, or revisions of ceded reinsurance agreements on a nonconsolidated basis unless the certified health plan is part of a consolidated group of insurers which utilizes a pooling arrangement or one hundred percent reinsurance agreement that affects the solvency and integrity of the certified health plan's reserves and the certified health plan ceded substantially all of its direct and assumed business to the pool. A certified health plan has ceded substantially all of its direct and assumed business to a pool if the certified health plan has less than one million dollars total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent of the certified health plan's net worth.[ 1995 c 86 § 12.]
WA Rev Code § 48.43.290 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.43 - Insurance Reform.|48.43.290 - Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.

RCW 48.43.290 Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.(1) Health plans issued or renewed on or after January 1, 2011, that include coverage for prescribed durable medical equipment and mobility enhancing equipment must include the sales tax or use tax calculation in plan payment, consistent with the application of sales tax in chapter 82.08 RCW or use tax in chapter 82.12 RCW.(2) The payment for covered durable medical equipment and mobility enhancing equipment must:(a) Reflect the negotiated provider agreement for the prescribed equipment; and(b) Separately identify the sales tax or use tax calculation that is included in the payment if the provider submitting a claim or invoice for reimbursement submits to the health plan a claim or invoice with a separate line item for the geographically adjusted sales tax.(3) The following definitions apply to this section unless the context clearly requires otherwise.(a) "Durable medical equipment" means equipment, including repair and replacement parts for durable medical equipment that:(i) Can withstand repeated use;(ii) Is primarily and customarily used to serve a medical purpose;(iii) Generally is not useful to a person in the absence of illness or injury; and(iv) Is not worn in or on the body.(b) "Mobility enhancing equipment" means equipment, including repair and replacement parts for mobility enhancing equipment that:(i) Is primarily and customarily used to provide or increase the ability to move from one place to another and that is appropriate for use either in a home or a motor vehicle;(ii) Is not generally used by persons with normal mobility; and(iii) Does not include any motor vehicle or equipment on a motor vehicle normally provided by a motor vehicle manufacturer.[ 2010 c 44 § 1.]