wa-law.org > bill > 2025-26 > HB 2106 > Original Bill

HB 2106 - Requiring carriers to provide substantive notice to health care providers and health care facilities about significant contract modifications.

Source

Section 1

The legislature finds that a healthy insurance market requires that major changes to contract terms and expectations between health carriers and providers or facilities be provided in a transparent manner that reflects mutual agreement between the parties. The legislature finds that unilateral changes by health carriers to payment or service delivery through policy changes violate principles of fair contracting and contribute to avoidable contract terminations and changes to access to services for patients. The legislature intends to remedy this by requiring certain policy changes be clearly communicated and mutually agreed upon by the parties before implementation.

Section 2

  1. 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:

    1. 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";

    2. 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;

    3. Include the specific language of the significant payer contract modification;

    4. Be sent to the person designated to receive notice under the terms of the relevant provider contract; and

    5. Inform the health care provider or health care facility that the provider or facility shall accept or reject the terms of the significant payer contract modification through written or electronic means during the notice period and that a rejection may not affect the terms of the health care provider's or health care facility's existing provider contract with the carrier.

  2. A health care provider or health care facility shall affirmatively accept or reject the significant payer contract modification. The rejection of a significant payer contract modification by the health care provider or health care facility may not affect the terms of the existing provider contract.

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    1. If a carrier fails to comply with the requirements of this section, the significant payer contract modification is void.

    2. If a provider contract contains a provision that violates this section, that provision of the provider contract is void.

  4. 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.

  5. For purposes of this section, the following definitions apply:

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      1. "Significant payer contract modification" means an action by a carrier, whether by policy, guideline, or otherwise, that results in any of the following changes for a health care provider or health care facility that has a provider contract with the carrier:

(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; or

(B) A change to provide payment policy for new technologies or services that have become available since the provider contract was last negotiated.

b. "Provider contract" has the same meaning as in RCW 48.43.730.

Section 3

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.

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