wa-law.org > bill > 2025-26 > HB 1589 > Third 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 provide the following to the provider:
The contact information for the carrier's primary contact for contract negotiations;
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; and
The carrier's payment methodology no less than 60 days in advance of the execution of the contract.
For new contracts, 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.
This section applies to a health care benefit manager acting on behalf of the carrier.
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.
This section applies to health plans issued or renewed on or after January 1, 2027.
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.
"Health care benefit manager" has the same meaning as provided in RCW 48.200.020.
A carrier shall provide notice of a significant payer contract modification to the contract representative of the relevant health care provider or health care facility no less than 90 days before the effective date of the significant payer contract modification. This notice must:
Specify the precise provider contract to which the significant payer contract modification applies and be conspicuously labeled as "notice of significant payer contract modification to provider contract";
Contain sufficient information about the change to allow the health care provider or health care facility to assess the financial impact, if any, of the significant payer contract modification, including at a minimum:
The effective date of the modification;
A detailed description of any change in methodology, payment, or administrative procedure;
Impacted current procedural terminology codes, healthcare common procedure coding system codes, modifiers, or any other data elements; and
The scope of services and service locations that the significant payer contract modification applies to;
Include the specific language of the significant payer contract modification; and
Be sent to the person designated to receive notice under the terms of the relevant provider contract.
A carrier shall include a summary of all notices of significant payer contract modifications in a single location on the carrier's website and in the carrier's newsletters no less than 90 days before the effective date of the significant payer contract modification.
For purposes of this section:
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(A) A decrease in fees, payments, or reimbursement to a participating health care provider or health care facility;
(B) A change in the payment methodology for determining fees, payments, or reimbursement to a participating health care provider or health care provider type including, but not limited to, a new or revised payer coding guideline or payer payment rule;
(C) A restriction on the site of service for specific services, or changes to payment or coverage based on site of service;
(D) A new requirement that services be separate or bundled;
(E) A change to prior authorization, inpatient notification, or claims submission requirements or processes;
(F) A restriction or exclusion from the contracted components of service such as provider administered drugs or supplies or a requirement that the contracted component be provided by or purchased from another entity; or
(G) A change of procedures that may reasonably be expected to significantly increase a health care provider's administrative expenses.
ii. "Significant payer contract modification" does not include:
(A) A change required by federal or state law;
(B) A change to provide payment policy for new technologies or services; or
(C) A change to reflect national changes to current procedural terminology codes and healthcare common procedure coding system procedure or international classification of diseases diagnosis coding.
b. "Provider contract" has the same meaning as in RCW 48.43.730.
Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 48.200.300 through 48.200.320, 48.43.440, 48.43.845, 48.43.732, section 2 of this act, and chapter 48.49 RCW.
The insurance commissioner may adopt any rules necessary to implement section 1 of this act in a manner consistent with RCW 48.02.060.