48.43.715  <<  48.43.720 >>   48.43.725

Reinsurance and risk adjustment programsAffordable care actRules.

(1)(a) The commissioner, in consultation with the board, shall adopt rules establishing the reinsurance and risk adjustment programs required by P.L. 111-148 of 2010, as amended.
(b) The commissioner must include in deliberations related to reinsurance rule making an analysis of an invisible high risk pool option, in which the full premium and risk associated with certain high-risk or high-cost enrollees would be ceded to the transitional reinsurance program. The analysis must include a determination as to whether that option is authorized under the federal reinsurance program regulations, whether the option would provide sufficiently comprehensive coverage for current nonmedicare high risk pool enrollees, and how an invisible high risk pool option could be designed to ensure that carriers ceding risk provide effective care management to high-risk or high-cost enrollees.
(2) Consistent with federal law, the rules for the reinsurance program must, at a minimum, establish:
(a) A mechanism to collect reinsurance contribution funds;
(b) A reinsurance payment formula; and
(c) A mechanism to disburse reinsurance payments.
(3)(a) The commissioner may adjust the rules adopted under this section as needed to preserve a healthy market both inside and outside of the exchange.
(b) The rules adopted under this section must identify and may require submission of the data needed to support operation of the reinsurance and risk adjustment programs established under this section. The commissioner must identify by rule the sources of the data, and other requirements related to the collection, validation, correction, interpretation, transmission or exchange, and retention of the data.
(4) The commissioner shall contract with one or more nonprofit entities to administer the risk adjustment and reinsurance programs.
(5) Contribution amounts for the transitional reinsurance program under section 1341 of P.L. 111-148 of 2010, as amended, may be increased to include amounts sufficient to cover the costs of administration of the reinsurance program including reasonable costs incurred for preoperational and planning activities related to the reinsurance program.


Effective date2012 c 87 §§ 4, 16, 18, and 19-23: See note following RCW 43.71.030.
Spiritual care services2012 c 87: See RCW 43.71.901.
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