wa-law.org > bill > 2025-26 > HB 1589 > Engrossed Second Substitute
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Prior to entering into or renewing a contract with a health care provider or a group of health care providers, a health carrier shall offer the provider a meaningful opportunity to participate in good faith negotiations regarding the terms of the contract. Only the following conduct violates this subsection:
Failure to furnish the provider with the name and contact information of a person the carrier has designated as the primary contact for contract negotiations;
When a contract is being renewed, failure to furnish the provider with a copy of the new contract with all changes indicated with strikeouts for deletions and underlining for new material along with a clean copy of the revised contract that incorporates amendments into the body of the contract and into any relevant exhibit or addendum;
Providing a standalone amendatory exhibit or addendum that requires the provider to conduct the provider's own analysis to produce a revised contract or agreement integrating amendments into the body of the contract or its relevant exhibits or addenda;
Except as provided in subsection (9) of this section, requiring a group of providers with the same employer or the same federal tax identification number to negotiate contracts individually, if the group of providers prefer to negotiate as a group; or
Failure to furnish the provider with a fee schedule no less than 60 days in advance of the execution of the contract in a manner that does not require access to a secure website or other portal, such as by emailing an electronic copy to the provider.
A health carrier's provider contract filings must include an attestation signed by both the health carrier and the provider that the requirements of (a) of this subsection were met. A contract filing is incomplete without the attestation required under this subsection and may not be approved by the commissioner. The commissioner shall, by rule, develop a standard form for the attestation required under this subsection.
If a provider elects to terminate a contract in place on the effective date of this section, the health carrier must provide the provider with the opportunity to renegotiate the contract consistent with the provisions of this subsection.
The commissioner may submit to the legislature recommended changes to this section to address additional conduct that the commissioner deems inconsistent with the good faith negotiations required under this subsection.
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Provider contracts entered into or renewed on or after the effective date of this section may not include:
An all-or-nothing clause; or
A requirement that the provider accept a discounted rate for services provided to enrollees under any other health plan or insurance product.
Provisions in contracts in place on the effective date of this section that violate the requirements in (a) of this subsection are against the public policy of the state of Washington and are unenforceable.
A health carrier shall provide contract and payment policy updates in a manner that does not require access to a secure website or other portal, such as by emailing an electronic copy to the provider.
A health carrier may not penalize a provider who appeals an adverse benefit determination by the health carrier in any way, including by charging a fee for the appeal or any external review of the appeal.
This section applies to a health care benefit manager acting on behalf of the carrier.
If the commissioner finds that a health carrier or a health care benefit manager has violated this section, the commissioner may, in addition to the commissioner's authority under RCW 48.02.080 and 48.200.050:
Impose a fine on the health carrier or health care benefit manager of up to $5,000 per violation;
Issue an order requiring corrective action against the health carrier, the health care benefit manager, or both the health carrier and the health care benefit manager; or
Both impose a fine and issue an order under (a) and (b) of this subsection.
For purposes of this section:
"Affiliate of a health carrier" means any provider related to a health carrier or hospital in any way by virtue of any form or amount of common control, operation, or management.
"All-or-nothing clause" means a provision in a provider contract that requires a provider to contract with multiple health plans or other insurance products offered by, or associated with, the health carrier.
"Health care benefit manager" has the same meaning as provided in RCW 48.200.020.
In addition to the definition in RCW 48.43.005, "health carrier" also includes a limited health care service contractor offering dental only coverage and a health carrier offering dental only coverage.
Any trade secrets or other confidential information disclosed to the commissioner under this section are confidential and exempt from public disclosure under chapter 42.56 RCW.
This section does not apply to negotiations between a health carrier and a provider who is:
An employee of the health carrier;
An employee of an affiliate of the health carrier;
Employed by a hospital or any affiliate of a hospital or health system; or
Employed by an entity that owns or operates multistate provider clinics.
Nothing in this section prohibits a health carrier from negotiating contracts with groups of providers.
Using data from the statewide all-payer health care claims database established under chapter 43.371 RCW, the commissioner shall analyze trends in allowed amounts for a representative sample of the most commonly billed current procedural terminology codes for a representative sample of the health professions impacted by this act.
The commissioner shall report the aggregate results of this analysis to the health care committees of the legislature on January 1st of each year, beginning January 1, 2027. The report must include an analysis of allowed amounts compared to data in previous years' reports submitted under this section.
This section expires January 31, 2031.
The insurance commissioner may adopt any rules necessary to implement this act consistent with RCW 48.02.060.
Section 1 of this act takes effect January 1, 2027.
If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2025, in the omnibus appropriations act, this act is null and void.