This bill amends RCW 48.49.135 and adds a new section to chapter 48.43 RCW to change how the Office of the Insurance Commissioner reviews and enforces network adequacy and to impose new contract negotiation duties on health carriers. It expands the commissioner’s review of proposed and in-force networks to require sufficient numbers of contracted providers in many hospital and diagnostic specialties and, beginning January 1, 2023, requires networks to include sufficient contracted behavioral health emergency services providers. The bill authorizes carriers to seek commissioner approval for an alternate access delivery arrangement when they cannot contract with in-network providers, sets submission and evidence requirements for those requests (including a five-day notice to certain out-of-network providers and a requirement that enrollees not face higher costs), allows an amendment and use of the dispute resolution process under RCW 48.49.040 if good-faith contracting efforts continue for three months, and provides that after the carrier’s required notification a provider may be reimbursed only up to the amount it charged at the time of notice and must accept that as payment in full. The bill creates a new statutory duty for carriers (and health care benefit managers acting on their behalf) to offer providers a meaningful opportunity to negotiate contract terms in good faith and lists specific negotiation practices that violate this duty. It prohibits provider contracts entered or renewed on or after the effective date from including an “all-or-nothing” clause or a requirement that a provider accept a discounted rate under another contract, requires carriers to provide contract and payment policy updates without forcing providers to use a secure portal, and exempts negotiations with providers who are carrier employees or hospital employees. Trade secrets or other confidential information disclosed to the commissioner under the new section are treated as exempt from public disclosure. The commissioner is given rulemaking authority to implement these changes. Sections 1 and 2 take effect January 1, 2027. This is a mix of modifications to existing law (RCW 48.49.135) and creation of a new statutory requirement in chapter 48.43 RCW. The changes are procedural and regulatory (network adequacy review, alternate access process, data requests, dispute resolution use) and contractual (new good-faith negotiation duty and prohibitions on certain contract clauses). The text provided does not include the full prior statutory language, the detailed procedures or rule content the commissioner will adopt, the specifics of how P.L. 116-260 interacts with these provisions, the description of the dispute resolution process in RCW 48.49.040, or the Bowman Family Foundation model data request form.

If enacted, the measure would force insurance companies and the managers who contract for them to show they have enough in-network specialists at hospitals and surgical centers (including behavioral health emergency providers) and to give providers a real chance to negotiate contract terms. Regulators would get new powers to review networks, require a standard data request, approve alternate access plans only if carriers meet strict notice and evidence rules, and use dispute resolution when carriers can’t find a contract; carriers must notify out-of-network providers within five days for services protected from balance billing and, after that notice, their payment becomes the provider’s full payment for that episode. The groups most affected are health carriers (including dental-only plans) and their contract managers, contracting specialists and hospital facilities, and the insurance commissioner—carriers will face more admin work, potential costs to expand or document networks, limits on using nonparticipating payments to meet adequacy rules, and new contract restrictions (no all-or-nothing clauses and limits on tying discounts to other contracts); providers gain stronger negotiation rights but may have reduced ability to bill over the carrier’s notified payment amount. Key implementation details are unclear from the excerpt: the exact timing of the behavioral health requirement (the text references January 1, 2023 but also says some sections don’t take effect until January 1, 2027), the commissioner’s specific rulemaking standards, and how the state rules will interact with the federal law and the cited dispute resolution process—these gaps will affect how quickly carriers must change practices and how much cost or disruption occurs.