reglab/housing_qa huggingface dataset:
WA Rev Code § 48.190.110 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs.|48.190.110 - Fees.

RCW 48.190.110 Fees.(1) The state risk manager shall establish and charge an investigation fee in an amount necessary to cover the costs for the initial review and approval of a joint self-insurance program. The fee must accompany the initial submission of the plan of operation and management.(2) The costs of subsequent reviews and investigations must be charged to the joint self-insurance program being reviewed or investigated in accordance with the actual time and expenses incurred in the review or investigation.(3) Any program failing to remit its assessment when due is subject to denial of permission to operate or to a cease and desist order until the assessment is paid.[ 2017 c 221 § 12.]
WA Rev Code § 48.190.120 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs.|48.190.120 - Civil immunity—Filings and publications.

RCW 48.190.120 Civil immunity—Filings and publications.(1) Any person who files reports or furnishes other information required under this title, required by the state risk manager under the authority granted under this title, or which is useful to the state risk manager in the administration of this title, is immune from liability in any civil action or suit arising from the filing of any such report or furnishing such information to the state risk manager, unless actual malice, fraud, or bad faith is shown.(2) The state risk manager and his or her agents and employees are immune from liability in any civil action or suit arising from the publication of any report or bulletins or arising from dissemination of information related to the official activities of the state risk manager unless actual malice, fraud, or bad faith is shown.(3) The immunity granted under this section is in addition to any common law or statutory privilege or immunity enjoyed by such person. This section is not intended to abrogate or modify in any way such common law or statutory privilege or immunity.[ 2017 c 221 § 13.]
WA Rev Code § 48.195.005 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.195 - Corporate Governance Annual Disclosure.|48.195.005 - Purpose—Application.

RCW 48.195.005 Purpose—Application.(1) The purpose of this chapter is to:(a) Provide the insurance commissioner a summary of an insurer or insurance group's corporate governance structure, policies, and practices to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance framework;(b) Outline the requirements for completing a corporate governance annual disclosure with the commissioner; and(c) Provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related to an insurer or insurance group's internal operations and proprietary and trade secret information which, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.(2) This chapter does not prescribe or impose corporate governance standards and internal procedures beyond that which is required under applicable corporate law. This chapter does not limit the commissioner's authority, or the rights or obligations of third parties, under chapter 48.03 RCW.(3) This chapter applies to all insurers domiciled in this state.[ 2018 c 30 § 1.]NOTES:Effective date—2018 c 30: "(1) The first filing of the corporate governance annual disclosure is 2019.(2) This act takes effect January 1, 2019." [ 2018 c 30 § 11.]
WA Rev Code § 48.195.010 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.195 - Corporate Governance Annual Disclosure.|48.195.010 - Definitions.

RCW 48.195.010 Definitions.The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Commissioner" means the insurance commissioner of this state.(2) "Corporate governance annual disclosure" means a confidential report filed by the insurer or insurance group under this chapter.(3) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in RCW 48.31B.005.(4) "Insurer" has the same meaning as set forth in RCW 48.31B.005.(5) "ORSA summary report" means the report filed under chapter 48.05A RCW.[ 2018 c 30 § 2.]NOTES:Effective date—2018 c 30: See note following RCW 48.195.005.
WA Rev Code § 48.195.030 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.195 - Corporate Governance Annual Disclosure.|48.195.030 - Responses to annual disclosure inquiries—Documentation and supporting information.

RCW 48.195.030 Responses to annual disclosure inquiries—Documentation and supporting information.(1) The insurer or insurance group has discretion over the responses to the corporate governance annual disclosure inquiries, provided the corporate governance annual disclosure contains the material information necessary to permit the commissioner to gain an understanding of the insurer's or insurance group's corporate governance structure, policies, and practices. The commissioner may request additional information that he or she deems material and necessary to provide the commissioner with a clear understanding of the corporate governance policies, the reporting or information system, or controls implementing those policies.(2) The corporate governance annual disclosure must be prepared consistent with the national association of insurance commissioners' corporate governance annual disclosure model rule which may be adopted by the commissioner. Documentation and supporting information must be maintained and made available upon examination or upon request of the commissioner.[ 2018 c 30 § 4.]NOTES:Effective date—2018 c 30: See note following RCW 48.195.005.
WA Rev Code § 48.195.060 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.195 - Corporate Governance Annual Disclosure.|48.195.060 - Failure to timely file—Penalties.

RCW 48.195.060 Failure to timely file—Penalties.Any insurer failing, without just cause, to timely file the corporate governance annual disclosure as required by this chapter is required, after notice and hearing under chapters 48.04 and 34.05 RCW, to pay a penalty of five hundred dollars for each day's delay, to be recovered by the commissioner and the penalty must be paid to the general fund of this state. The maximum penalty under this section is one hundred thousand dollars. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.[ 2018 c 30 § 7.]NOTES:Effective date—2018 c 30: See note following RCW 48.195.005.
WA Rev Code § 48.195.100 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.195 - Corporate Governance Annual Disclosure.|48.195.100 - Rules.

RCW 48.195.100 Rules.The commissioner may, under chapter 34.05 RCW, adopt rules to implement and administer this chapter, including the national association of insurance commissioners' corporate governance annual disclosure model rule.[ 2018 c 30 § 8.]NOTES:Effective date—2018 c 30: See note following RCW 48.195.005.
WA Rev Code § 48.200.010 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.010 - Findings—Intent.

RCW 48.200.010 Findings—Intent. (Effective January 1, 2022.)(1) The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and health care benefit managers. Health care benefit managers acting as intermediaries between carriers, health care providers, and patients exercise broad discretion to affect health care services recommended and delivered by providers and the health care choices of patients. Regularly, these health care benefit managers are making health care decisions on behalf of carriers. However, unlike carriers, health care benefit managers are not currently regulated.(2) Therefore, the legislature finds that it is in the best interest of the public to create a separate chapter in this title for health care benefit managers.(3) The legislature intends to protect and promote the health, safety, and welfare of Washington residents by establishing standards for regulatory oversight of health care benefit managers.[ 2020 c 240 § 1.]
WA Rev Code § 48.200.030 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.030 - Registration requirements—Application—Fees—Retention of transaction records.

RCW 48.200.030 Registration requirements—Application—Fees—Retention of transaction records. (Effective January 1, 2022.)(1) To conduct business in this state, a health care benefit manager must register with the commissioner and annually renew the registration.(2) To apply for registration under this section, a health care benefit manager must:(a) Submit an application on forms and in a manner prescribed by the commissioner and verified by the applicant by affidavit or declaration under chapter 5.50 RCW. Applications must contain at least the following information:(i) The identity of the health care benefit manager and of persons with any ownership or controlling interest in the applicant including relevant business licenses and tax identification numbers, and the identity of any entity that the health care benefit manager has a controlling interest in;(ii) The business name, address, phone number, and contact person for the health care benefit manager;(iii) Any areas of specialty such as pharmacy benefit management, radiology benefit management, laboratory benefit management, mental health benefit management, or other specialty; and(iv) Any other information as the commissioner may reasonably require.(b) Pay an initial registration fee and annual renewal registration fee as established in rule by the commissioner. The fees for each registration must be set by the commissioner in an amount that ensures the registration, renewal, and oversight activities are self-supporting. If one health care benefit manager has a contract with more than one carrier, the health care benefit manager must complete only one application providing the details necessary for each contract.(3) All receipts from fees collected by the commissioner under this section must be deposited into the insurance commissioner's regulatory account created in RCW 48.02.190.(4) Before approving an application for or renewal of a registration, the commissioner must find that the health care benefit manager:(a) Has not committed any act that would result in denial, suspension, or revocation of a registration;(b) Has paid the required fees; and(c) Has the capacity to comply with, and has designated a person responsible for, compliance with state and federal laws.(5) Any material change in the information provided to obtain or renew a registration must be filed with the commissioner within thirty days of the change.(6) Every registered health care benefit manager must retain a record of all transactions completed for a period of not less than seven years from the date of their creation. All such records as to any particular transaction must be kept available and open to inspection by the commissioner during the seven years after the date of completion of such transaction.[ 2020 c 240 § 3.]
WA Rev Code § 48.200.040 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.040 - Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.

RCW 48.200.040 Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality. (Effective January 1, 2022.)(1) A health care benefit manager may not provide health care benefit management services to a health carrier or employee benefits programs without a written agreement describing the rights and responsibilities of the parties conforming to the provisions of this chapter and any rules adopted by the commissioner to implement or enforce this chapter including rules governing contract content.(2) A health care benefit manager must file with the commissioner in the form and manner prescribed by the commissioner, every benefit management contract and contract amendment between the health care benefit manager and a provider, pharmacy, pharmacy services administration organization, or other health care benefit manager, entered into directly or indirectly in support of a contract with a carrier or employee benefits programs, within thirty days following the effective date of the contract or contract amendment.(3) Contracts filed under this section are confidential and not subject to public inspection under RCW 48.02.120(2), or public disclosure under chapter 42.56 RCW, if filed in accordance with the procedures for submitting confidential filings through the system for electronic rate and form filings and the general filing instructions as set forth by the commissioner. In the event the referenced filing fails to comply with the filing instructions setting forth the process to withhold the contract from public inspection, and the health care benefit manager indicates that the contract is to be withheld from public inspection, the commissioner must reject the filing and notify the health care benefit manager through the system for electronic rate and form filings to amend its filing to comply with the confidentiality filing instructions.[ 2020 c 240 § 4.]
WA Rev Code § 48.200.210 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.210 - Definitions applicable to RCW 48.200.220 through 48.200.290.

RCW 48.200.210 Definitions applicable to RCW 48.200.220 through 48.200.290. (Effective January 1, 2022.)The definitions in this section apply throughout this section and RCW 48.200.220 through 48.200.290 unless the context clearly requires otherwise.(1) "Audit" means an on-site or remote review of the records of a pharmacy by or on behalf of an entity.(2) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service.(3) "Clerical error" means a minor error:(a) In the keeping, recording, or transcribing of records or documents or in the handling of electronic or hard copies of correspondence;(b) That does not result in financial harm to an entity; and(c) That does not involve dispensing an incorrect dose, amount, or type of medication, or dispensing a prescription drug to the wrong person.(4) "Entity" includes:(a) A pharmacy benefit manager;(b) An insurer;(c) A third-party payor;(d) A state agency; or(e) A person that represents or is employed by one of the entities described in this subsection.(5) "Fraud" means knowingly and willfully executing or attempting to execute a scheme, in connection with the delivery of or payment for health care benefits, items, or services, that uses false or misleading pretenses, representations, or promises to obtain any money or property owned by or under the custody or control of any person.(6) "Pharmacist" has the same meaning as in RCW 18.64.011.(7) "Pharmacy" has the same meaning as in RCW 18.64.011.(8) "Third-party payor" means a person licensed under RCW 48.39.005.[ 2020 c 240 § 10; 2014 c 213 § 3. Formerly RCW 19.340.020.]
WA Rev Code § 48.200.220 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.220 - Auditing of claims—Requirements—Prohibited practices.

RCW 48.200.220 Auditing of claims—Requirements—Prohibited practices. (Effective January 1, 2022.)An entity that audits claims or an independent third party that contracts with an entity to audit claims:(1) Must establish, in writing, a procedure for a pharmacy to appeal the entity's findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy's claims;(2) May not conduct an audit of a claim more than twenty-four months after the date the claim was adjudicated by the entity;(3) Must give at least fifteen days' advance written notice of an on-site audit to the pharmacy or corporate headquarters of the pharmacy;(4) May not conduct an on-site audit during the first five days of any month without the pharmacy's consent;(5) Must conduct the audit in consultation with a pharmacist who is licensed by this or another state if the audit involves clinical or professional judgment;(6) May not conduct an on-site audit of more than two hundred fifty unique prescriptions of a pharmacy in any twelve-month period except in cases of alleged fraud;(7) May not conduct more than one on-site audit of a pharmacy in any twelve-month period;(8) Must audit each pharmacy under the same standards and parameters that the entity uses to audit other similarly situated pharmacies;(9) Must pay any outstanding claims of a pharmacy no more than forty-five days after the earlier of the date all appeals are concluded or the date a final report is issued under RCW 48.200.260(3);(10) May not include dispensing fees or interest in the amount of any overpayment assessed on a claim unless the overpaid claim was for a prescription that was not filled correctly;(11) May not recoup costs associated with:(a) Clerical errors; or(b) Other errors that do not result in financial harm to the entity or a consumer; and(12) May not charge a pharmacy for a denied or disputed claim until the audit and the appeals procedure established under subsection (1) of this section are final.[ 2020 c 240 § 11; 2014 c 213 § 4. Formerly RCW 19.340.040.]
WA Rev Code § 48.200.230 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.230 - Basis of finding of claim.

RCW 48.200.230 Basis of finding of claim. (Effective January 1, 2022.)An entity's finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation, or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs.[ 2014 c 213 § 5. Formerly RCW 19.340.050.]
WA Rev Code § 48.200.240 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.240 - Contract with third party—Prohibited practices.

RCW 48.200.240 Contract with third party—Prohibited practices. (Effective January 1, 2022.)An entity that contracts with an independent third party to conduct audits may not:(1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or(2) Disclose information obtained during an audit except to the contracting entity, the pharmacy subject to the audit, or the holder of the policy or certificate of insurance that paid the claim.[ 2014 c 213 § 6. Formerly RCW 19.340.060.]
WA Rev Code § 48.200.250 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.250 - Evidence of validation of claim.

RCW 48.200.250 Evidence of validation of claim. (Effective January 1, 2022.)For purposes of RCW 48.200.210 through 48.200.270, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim:(1) An electronic or physical copy of a valid prescription if the prescribed drug was, within fourteen days of the dispensing date:(a) Picked up by the patient or the patient's designee;(b) Delivered by the pharmacy to the patient; or(c) Sent by the pharmacy to the patient using the United States postal service or other common carrier;(2) Point of sale electronic register data showing purchase of the prescribed drug, medical supply, or service by the patient or the patient's designee; or(3) Electronic records, including electronic beneficiary signature logs, electronically scanned and stored patient records maintained at or accessible to the audited pharmacy's central operations, and any other reasonably clear and accurate electronic documentation that corresponds to a claim.[ 2020 c 240 § 12; 2014 c 213 § 7. Formerly RCW 19.340.070.]
WA Rev Code § 48.200.260 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.260 - Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.

RCW 48.200.260 Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds. (Effective January 1, 2022.)(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than forty-five days after the date on which the audit was completed and must be sent:(i) By mail or common carrier with a return receipt requested; or(ii) Electronically with electronic receipt confirmation.(b) An entity shall provide a pharmacy receiving a preliminary report under this subsection no fewer than forty-five days after receiving the report to contest the report or any findings in the report in accordance with the appeals procedure established under RCW 48.200.220(1) and must allow the submission of additional documentation in support of the claim. The entity shall consider a reasonable request for an extension of time to submit documentation to contest the report or any findings in the report.(2) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to resubmit the claim using any commercially reasonable method, including facsimile, mail, or email.(3) An entity must provide a pharmacy that is the subject of an audit with a final report of the audit no later than sixty days after the later of the date the preliminary report was received or the date the pharmacy contested the report using the appeals procedure established under RCW 48.200.220(1). The final report must include a final accounting of all moneys to be recovered by the entity.(4) Recoupment of disputed funds from a pharmacy by an entity or repayment of funds to an entity by a pharmacy, unless otherwise agreed to by the entity and the pharmacy, shall occur after the audit and the appeals procedure established under RCW 48.200.220(1) are final. If the identified discrepancy for an individual audit exceeds forty thousand dollars, any future payments to the pharmacy may be withheld by the entity until the audit and the appeals procedure established under RCW 48.200.220(1) are final.[ 2020 c 240 § 13; 2014 c 213 § 8. Formerly RCW 19.340.080.]
WA Rev Code § 48.200.270 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.200 - Health Care Benefit Managers.|48.200.270 - Application.

RCW 48.200.270 Application. (Effective January 1, 2022.)RCW 48.200.210 through 48.200.270 do not:(1) Preclude an entity from instituting an action for fraud against a pharmacy;(2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is indicated by physical review, review of claims data or statements, or other investigative methods; or(3) Apply to a state agency that is conducting audits or a person that has contracted with a state agency to conduct audits of pharmacy records for prescription drugs paid for by the state medical assistance program.[ 2020 c 240 § 14; 2014 c 213 § 9. Formerly RCW 19.340.090.]