On March 7, the Washington state house passed House Bill 1688, providing greater alignment between Washington’s Balance Billing Protection Act (BBPA) with the federal No Surprises Act. In coordination with the CAP, the Washington State Society of Pathologists (WSSP) partnered with the Washington State Medical Association (WSMA) to include provisions to strengthen network adequacy review of health insurance plans by the Department of Insurance. The CAP advocates for states to require health plans to have adequate networks of hospital-based physicians, including pathologists.

Other elements of the legislation adversely altered the current Washington state law. Under the bill, on July 1, 2023, or a later date determined by the Commissioner of Insurance, the current Washington state arbitration process will be supplanted with the federal NSA out-of-network independent dispute resolution process. Unlike the federal law, the current Washington state out-of-network arbitration system allows for the consideration of billed charges, a favorable methodology urged by physicians that no longer had the support of the Office of the Insurance Commissioner (OIC) or the legislature, in light of the federal NSA.

However, the WSSP, the CAP, and the WSMA successfully amended the bill to tighten the Commissioner of Insurance’s review of health plan carrier’s networks for hospital-based physician network adequacy, including pathologists and access to laboratory services. Furthermore, the legislation ensures health plan carriers may not utilize its payment to out-of-network providers or facilities under the BBPA or the No Surprises Act to satisfy network adequacy standards unless certain criteria is met. The WSSP and the CAP actively advocated for Washington’s current network adequacy standards enacted in 2019 to ensure proper oversight of network adequacy by the OIC.

Additionally, the physician coalition advocated before the OIC and legislators to insert guardrails on the use of alternate access delivery requests. Alternate access delivery requests are used to fill access gaps in a health carrier’s network and protect consumers from high out-of-pocket costs. Under current law, alternate access delivery requests may require health carriers to pay billed charges to out-of-network providers while protecting consumers from adverse cost-sharing.

As advocated by the WSMA, the WSSP, and the CAP, the amended bill ensures that the OIC can only approve an alternate access delivery request if a health insurance plan demonstrates "substantial evidence of good faith efforts on its part to contract with providers and facilities," and meets other specified criteria. Under alternate access delivery requests, the carrier may reimburse providers at billed charges for three months as advocated by the physician coalition to deter the use of alternate access delivery requests to circumvent strengthened network adequacy requirements.

Subsequent to that period, a health insurance plan may submit a request to OIC to set reimbursement by the state’s arbitration process for the remainder of the alternate access delivery request. The amended bill ensures incentives are retained for carriers and providers to contract without jeopardizing quality care and access to health care services for consumers.

The bill awaits consideration by Governor Jay Inslee and will take effect upon enactment.