January 06, 2022

Washington State Legislature Files Measure to Align With Federal No Surprises Act

A bill (House Bill 1688/Senate Bill 5618) was filed in the Washington State Legislature that would align state law with the federal No Surprises Act (NSA). A hearing about the bill is scheduled for Jan. 12.

In 2019, the state legislature enacted the Balance Billing Protection Act (BBPA) to prohibit balance billing for emergency services and for non-emergency “surgical and ancillary services” (including radiology) rendered at in-network hospitals. In December 2020, Congress enacted the NSA which took effect on Jan. 1.

House Bill 1688 directs the Office of the Insurance Commissioner (OIC) to contract with the state’s all-payer claims database to provide a biennial analysis of commercial health plan claims data to assess the impact of balance billing laws on payments to contracted and out-of-network providers and utilization of out-of-network services. It also removes definitions to “surgical or ancillary services” (surgery, anesthesiology, pathology, radiology, laboratory or hospitalist services) and replaces it with “non-emergency healthcare services provided by nonparticipating providers at certain participating facilities” to align with the federal definition.

It also broadens insurance coverage requirements of emergency services to extend beyond screening and stabilization, to include post-stabilization services. As currently written, the measure does not seek to adapt federal dispute resolution criteria; however, it includes a stipulation that until Jan. 1, “or a later date determined by the Commissioner,” existing BBPA “commercially reasonable” payment standard and arbitration processes apply to emergency services and relevant non-emergency healthcare services for state regulated health plans and those self-funded plans that opt in to complying with the BBPA.

If you have questions or would like more information, contact Eugenia Brandt, Director State Affairs.