This bill amends existing laws regarding the relationships between health carriers and contracting providers, specifically focusing on the adequacy of provider networks and the negotiation processes for contracts. It requires the insurance commissioner to assess whether proposed and existing provider networks include a sufficient number of contracted providers across various specialties, including behavioral health emergency services starting January 1, 2023. Additionally, the bill introduces a new requirement for health carriers to ensure that enrollees do not incur higher costs when accessing services through alternate delivery requests, and mandates that carriers provide substantial evidence of good faith efforts to contract with providers.

Furthermore, the bill establishes new provisions for contract negotiations between health carriers and providers, ensuring that providers have a meaningful opportunity to negotiate terms in good faith. It prohibits certain practices, such as all-or-nothing clauses and the requirement for providers to accept discounted rates under other contracts. The bill also mandates that health carriers provide updates on contracts and payment policies in a manner that does not require access to secure websites. The new sections of the bill will take effect on January 1, 2027, and the insurance commissioner is authorized to adopt necessary rules for implementation.

Statutes affected:
Original Bill: 48.49.135