SB 5262 — Correcting obsolete or erroneous references in statutes administered by the insurance commissioner.

p.(2) Nothing in this section may be construed to prevent a carrier from appropriately utilizing reasonable medical management techniques.

9 SSB 5262 (2) Nothing in this section may be construed to prevent a carrier from appropriately utilizing reasonable medical management techniques.

(b)p. A health carrier may not apply categorical cosmetic or blanket exclusions to gender-affirming treatment.

10 SB 5262 (b) A health carrier may not apply categorical cosmetic or blanket exclusions to gender-affirming treatment.

(6) By December 1, 2022, the commissioner, in consultation with the health care authority and the department of health, must issue a p.report on geographic access to gender-affirming treatment across the state.

10 SSB 5262 report on geographic access to gender-affirming treatment across the state.

(8) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement subsections (1) and (2) of this section,p. consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.

11 SB 5262 section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.

9.10.

RCW 48.43.115 and 2020 c 80 s 37 are each amended to read as follows:

(1) The legislature recognizes the role of health care providers as the appropriate authority to determine and establish the delivery of quality health care services to maternity patients and their newly born children.

It is the intent of the legislature to recognize patient preference and the clinical sovereignty of providers as they make determinations regarding services provided and the length of time individual patients may need to remain in a health care facility after giving birth.

It is not the intent of the legislature to diminish a carrier's ability to utilize managed care strategies but to ensure the clinical judgment of the provider is not undermined by restrictive carrier contracts or utilization review criteria that fail to recognize individual postpartum needs.

(2) Unless otherwise specifically provided, the following definitions apply throughout this section:

(a) "Attending provider" means a provider who:

Has clinical hospital privileges consistent with RCW 70.43.020;

is included in a provider network of the carrier that is providing coverage;

and is a physician licensed under chapter 18.57 or 18.71 RCW, a certified nurse midwife licensed under chapter 18.79 RCW, a midwife licensed under chapter 18.50 RCW, a physician's assistant licensed under chapter 18.71A RCW, or an advanced practice registered nurse ((practitioner)) licensed under chapter 18.79 RCW.

(b) "Health carrier" or "carrier" means disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, health maintenance organizations regulated under chapter 48.46 RCW, plans operating under the health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapter 48.41 RCW, and insuring entities regulated under this chapter.

(3)(a) Every health carrier that provides coverage for maternity services must permit the attending provider, in consultation with the mother, to make decisions on the length of inpatient stay, rather than making such decisions through contracts or agreements between p.

12 SB 5262 providers, hospitals, and insurers.

These decisions must be based on accepted medical practice.

(b) Covered eligible services may not be denied for inpatient, postdelivery care to a mother and her newly born child after a vaginal delivery or a cesarean section delivery for such care as ordered by the attending provider in consultation with the mother.

(c) At the time of discharge, determination of the type and location of follow-up care must be made by the attending provider in consultation with the mother rather than by contract or agreement between the hospital and the insurer.

These decisions must be based on accepted medical practice.

(d) Covered eligible services may not be denied for follow-up care, including in-person care, as ordered by the attending provider in consultation with the mother.

Coverage for providers of follow-up services must include, but need not be limited to, attending providers as defined in this section, home health agencies licensed under chapter 70.127 RCW, and registered nurses licensed under chapter 18.79 RCW.

(e) This section does not require attending providers to authorize care they believe to be medically unnecessary.

(((f) Coverage for the newly born child must be no less than the coverage of the child's mother for no less than three weeks, even if there are separate hospital admissions.)) (4) A carrier that provides coverage for maternity services may not deselect, terminate the services of, require additional documentation from, require additional utilization review of, reduce payments to, or otherwise provide financial disincentives to any attending provider or health care facility solely as a result of the attending provider or health care facility ordering care consistent with this section.

This section does not prevent any insurer from reimbursing an attending provider or health care facility on a capitated, case rate, or other financial incentive basis.

(5) Every carrier that provides coverage for maternity services must provide notice to policyholders regarding the coverage required under this section.

The notice must be in writing and must be transmitted at the earliest of the next mailing to the policyholder, the yearly summary of benefits sent to the policyholder, or January 1 of the year following June 6, 1996.

(6) This section does not establish a standard of medical care.

p.

13 SB 5262 (7) This section applies to coverage for maternity services under a contract issued or renewed by a health carrier after June 6, 1996, and applies to plans operating under the health care authority under chapter 41.05 RCW beginning January 1, 1998.

Sec.

11.

p.(c) A health carrier may require prior authorization or adopt other appropriate utilization controls in approving coverage for medically necessary hearing instruments.

11 SSB 5262 (c) A health carrier may require prior authorization or adopt other appropriate utilization controls in approving coverage for medically necessary hearing instruments.

For such a qualifying health plan, the carrier may apply a deductible to coverage of the services covered under this section only at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals fromp. the enrollee's health savings account under internal revenue service laws and regulations.

14 SB 5262 from the enrollee's health savings account under internal revenue service laws and regulations.

10.12.

p.(d) The dental loss ratio that is computed by dividing the total amount of dental payments by the total amount of dental revenues;

12 SSB 5262 (d) The dental loss ratio that is computed by dividing the total amount of dental payments by the total amount of dental revenues;

(3) The commissioner shall make the information reported under this section available to the public ((in a format that allows comparisonp. among carriers through a searchable)) on the commissioner's public website on the internet.

15 SB 5262 comparison among carriers through a searchable)) on the commissioner's public website on the internet.

11.13.

12.14.

p.(2) The summaries must be available by April 30th of each year, unless the commissioner notifies legislative committees by March 15th that data are not available and informs the committees when the summaries will be completed.

13 SSB 5262 (2) The summaries must be available by April 30th of each year, unless the commissioner notifies legislative committees by March 15th that data are not available and informs the committees when the summaries will be completed.

Sec.p.

13.16 SB 5262 Sec.

15.

p.(i) An analysis of the financial ((reports)) data of the authorized insurers with a combined market share of at least ((ninety)) 90 percent of direct written medical malpractice premium in Washington state for the prior calendar year;

14 SSB 5262 (i) An analysis of the financial ((reports)) data of the authorized insurers with a combined market share of at least ((ninety)) 90 percent of direct written medical malpractice premium in Washington state for the prior calendar year;

(c)p. A comparison of loss ratios and the profitability of medical malpractice insurance in Washington state to other states based on financial ((reports)) data filed with the national association of insurance commissioners and any other source of information the commissioner deems relevant;

17 SB 5262 (c) A comparison of loss ratios and the profitability of medical malpractice insurance in Washington state to other states based on financial ((reports)) data filed with the national association of insurance commissioners and any other source of information the commissioner deems relevant;

14.16.

The annual statements and the data reported in them are confidential and exempt p.from public disclosure, and from the requirements of chapter 42.56 RCW.

15 SSB 5262 from public disclosure, and from the requirements of chapter 42.56 RCW.

(3) The commissioner shall report annually to the legislature on direct practices including, but not limited to, participation trends, complaints received, voluntary data reported by the direct practices, andp. any necessary modifications to this chapter.

18 SB 5262 and any necessary modifications to this chapter.

15.17.

p.(b) The identities of the applicant's executive officers or other officers directly responsible for the waiver business;

16 SSB 5262 (b) The identities of the applicant's executive officers or other officers directly responsible for the waiver business;

(4)p. Once registered, the applicant shall keep the information required for registration current by reporting changes within ((thirty)) 30 days after the end of the month in which the change occurs.

19 SB 5262 (4) Once registered, the applicant shall keep the information required for registration current by reporting changes within ((thirty)) 30 days after the end of the month in which the change occurs.

16.18.

(3) RCW 48.43.04948.19.500 (Health(Motor carriervehicle datainsurance ——Seat Informationbelts, frometc) annualand statement—1989 Formatc prescribed11 bys commissioner20 —& Public1987 availability) and 2006 c 104310 s 2;1;

(4) RCW 48.43.65048.43.049 (Fixed(Health paymentcarrier insurancedata products—— Commissioner'sInformation from annual report)statement— Format prescribed by commissioner — Public availability) and 20072006 c 296104 s 6;2;

(5) RCW 48.140.07048.43.650 (Model(Fixed statisticalpayment reportinginsurance standardsproducts— —Commissioner's Reportannual toreport) legislature) and 20062007 c 8296 s 207;6;

and (6) RCW 48.160.00548.140.070 (Guaranteed(Model assetstatistical protectionreporting waiverstandards account)— Report to legislature) and 20092006 c 3348 s 10.207;

and (7) RCW 48.160.005 (Guaranteed asset protection waiver account) and 2009 c 334 s 10.

17.19.

Section 67 of this act takes effect January 1, 2026.

1720 SSBSB 5262