Engrossed Substitute Senate Bill 6210 amends existing law and adds new statutory sections to govern how the Washington Health Benefit Exchange certifies qualified health plans. It modifies RCW 43.71.020 and RCW 43.71.065, adds new sections to chapter 43.71 RCW, and adds a new confidentiality exemption to chapter 42.56 RCW. The bill authorizes the exchange to adopt annual “market factor certification criteria” meant to address access and affordability when certifying plans, and it makes meeting those criteria one of four conditions for a plan to be certified as a qualified health plan on the exchange (alongside meeting Title 48 requirements, applicable federal QHP standards, and including tribal and urban Indian clinics as essential community providers, with a specified exemption for integrated delivery systems). The bill creates procedural and substantive regulatory changes: it directs the exchange to review market conditions each year and may adopt objectively defined, measurable, uniformly applied criteria (for example, requiring plans at more than one carrier, maximizing federal premium tax credits, efficiently using state premium assistance, and offering required metal levels). It requires consultation with the insurance commissioner and the Health Care Authority, stakeholder input including tribes, and a public timeline for developing criteria for plan years 2028 and later, with specific deadlines from preliminary criteria identification through final publication and carrier notice. Carriers must provide specified information in a March–May window each year and may seek waivers under a set schedule; the exchange must decide waivers before carriers submit preliminary filings to the commissioner. The bill also adds a confidentiality exemption for carrier submissions to the exchange and prohibits market-factor criteria from imposing hospital or provider participation or reimbursement limits except as required by law. The act also makes several governance and administrative adjustments: it retains and clarifies the exchange’s board composition, appointment terms, meeting and confidentiality rules, tribal consultation, travel reimbursement, and deadlines for state agencies to respond to information requests and for the exchange to reimburse agencies. It requires joint work by the exchange and the commissioner in any county with one or fewer carriers to pursue a pathway toward having at least two carriers offer plans, including discussion of hospitals contracting with multiple carriers. The provided text is incomplete in parts: the full list of measures the exchange may consider when developing market factor criteria is cut off, the text of “section 3 of this act” is not included, and the exact wording of the new chapter 42.56 RCW provision and any other created section(s) is not fully shown here.

If enacted, the exchange would gain a new, recurring responsibility to set objective, measurable “market factor” rules that plans must meet to be sold on the exchange, and to review market conditions each year before certification. That means the exchange will be running a formal multi-step process (identifying preliminary criteria, taking objections, holding hearings, publishing final rules) for plan years 2028 and later, requiring insurers to submit offering details between March and May, allowing insurers to request waivers, keeping submitted data confidential, and reporting to the Legislature starting in 2030. The exchange must also ensure certified plans include tribal and urban Indian clinics as essential community providers, and work with the insurance regulator to try to get at least two carriers offering plans in counties with one or fewer carriers. The main impacts fall on the exchange (more rulemaking, consultation, hearings, data review, and reimbursing state agencies for information), health insurers (new compliance, reporting, possible product or network changes, and potential costs to meet the criteria), hospitals in single-carrier counties (pressure to contract with multiple insurers), and state agencies called on for data. Because the rules must be consistent with insurance commissioner standards and cannot make premiums actuarially unsound, the insurance regulator retains key limits on what the exchange can require. Important details that affect how burdensome or far‑reaching this will be—such as the complete list of measures the exchange may use and the contents of the referenced section 3—are not included here, so the full scope and likely costs remain partially uncertain.