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182-40-0900  <<  182-40-1000 >>   182-40-1100

(Effective January 1, 2027)

PDFWAC 182-40-1000

Primary care, behavioral health, and critical access hospital underpayments.

(1) When the authority determines a contractor reimbursed primary care, behavioral health providers, or critical access hospitals below the required payment threshold for any plan year, as specified in WAC 182-40-0300 and 182-40-0400, the authority provides written notice of noncompliance to the contractor.
(2) When the authority determines a contractor failed to meet the requirements under WAC 182-40-0300 and 182-40-0400 for consecutive plan years due to making underpayments, the authority may also assess a fine according to WAC 182-40-1400.
(3) The authority may also require the contractor to create a corrective action plan or demonstrate corrective action. See WAC 182-40-1200.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 41.05.028. WSR 25-24-066, s 182-40-1000, filed 12/1/25, effective 1/1/27.]