SB 5579 — Prohibiting health carriers, facilities, and providers from making any public statements of any potential or planned contract terminations unless it satisfies a legal obligation.

S-1716.1S-0890.1 SUBSTITUTE SENATE BILL 5579 State of Washington 69th Legislature 2025 Regular Session By Senate Health & Long-Term Care (originally sponsored by Senators Cleveland, Muzzall, and Valdez)Valdez READRead FIRSTfirst TIMEtime 02/21/25.01/30/25.

Referred to Committee on Health & Long- Term Care.

and adding a new section to chapter 48.43 RCW;RCW.

creating a new section;

and prescribing penalties.

The legislature finds that public communications and notices to health plan members by carriers, health care providers, or health care facilities during contract negotiations have created concerns for enrollees, patients, and affected communities.

Therefore, the legislature intends to provide consistent policies for communication with enrollees and affected communities regarding potential contract terminations.

NEW SECTION.

Sec.

2.

(1) In the case of a provider contractcontract, as defined in RCW 48.43.730, that is expiring by its own terms or for which one party has given notice to the other party of an intended termination without cause in accordance with the terms of the provider contract, neither the health care provider, theas healthdefined carein facility,RCW 48.43.730, nor the carrier may make or cause to be made p.public statements, including by directly communicating with impacted individuals including enrollees and patients, regarding such expiration or termination, unless:

1(a) SSBSuch 5579disclosure publicis statements, including by directly communicating with impacted health plan enrollees and patients, regarding such expiration or termination until 45 days prior to thesatisfy terminationa date,legal unless:obligation;

(a)or (b) The disclosureexpiration isor requiredtermination tohas satisfyalready abeen specificdisclosed publicly because of a legal obligation;obligation.

or(2) (b)The theattorney expirationgeneral ormay terminationenforce hasthis alreadysection beenunder disclosedthe publiclyconsumer becauseprotection ofact, achapter legal19.86 obligation.RCW.

(2)For Nothingactions inbrought thisby sectionthe requiresattorney ageneral carrier, health care facility, or health care provider to provideenforce noticethis ofsection, athe potentiallegislature terminationfinds top. enrollees, unless required to do so as a regulatory or legal requirement.

(3)1 PublicSB statements5579 orthat communicationthe withpractices healthcovered planby enrolleesthis orsection patientsare bymatters avitally carrier,affecting healththe carepublic facility,interest orfor healththe carepurpose providerof mayapplying the consumer protection act, chapter 19.86 RCW, and that a violation of this section is not occurreasonable priorin relation to the datedevelopment theand carrier,preservation healthof carebusiness facility,and is an unfair or healthdeceptive careact providerin hastrade givenor writtencommerce noticeand ofan theunfair terminationmethod toof competition for the otherpurpose party,of unlessapplying agreedthe uponconsumer byprotection bothact, parties.chapter 19.86 RCW.

(4)(a) The commissioner, in consultation with health carriers, health care providers, health care facilities, and consumers, must develop standard template language for notices sent to health plan enrollees by health carriers, health care providers, or health care facilities pursuant to this section.

(b) Templates developed pursuant to this section must include, at a minimum:

(i) A reference to the specific facility or facilities by name that would be affected by the potential contract termination and an indication of whether the potential termination would apply to hospital-based providers;

(ii) Direction to enrollees related to appointments that are scheduled past the date of the potential contract termination date;

and (iii) Information concerning the enrollee's continuity of care rights pursuant to the federal no surprises act, 42 U.S.C.

Sec.

300gg-111.

(c) All notices must be reviewed and approved by the commissioner before being used in any manner.

(5)(a) The commissioner is authorized to enforce the provisions of this act that are applicable to or regulate the conduct of carriers issuing or renewing health plans or grandfathered health plans to residents of Washington state on or after January 1, 2026.

In addition to the enforcement actions authorized under RCW 48.02.080, the commissioner may impose a civil monetary penalty in an p.

2 SSB 5579 amount not to exceed $100 for each day for each individual with respect to which a failure to comply with these provisions occurs.

(b) If the commissioner has cause to believe that any health care provider or health care facility has engaged in a pattern of unresolved violations of this section, the commissioner may submit information to the department of health or the appropriate disciplining authority for action.

Prior to submitting information to the department of health or the appropriate disciplining authority, the commissioner may provide the health care provider or health care facility with an opportunity to cure the alleged violations or explain why the actions in question did not violate this section.

(c) If any health care provider or health care facility has engaged in a pattern of unresolved violations of this section, the department of health or the appropriate disciplining authority may levy a fine or cost recovery upon the health care provider or health care facility in an amount not to exceed the applicable statutory amount per violation and take other action as permitted under the authority of the department of health or disciplining authority.

Upon completion of its review of any potential violation submitted by the commissioner or initiated directly by an enrollee, the department of health or the disciplining authority shall notify the commissioner of the results of the review, including whether the violation was substantiated and any enforcement action taken as a result of a finding of a substantiated violation.

(6) For the purposes of this section, "provider contract" means a written contract between a carrier and a health care provider or health care facility, as they are defined in RCW 48.43.005, for any health care services rendered to an enrollee.

32 SSBSB 5579