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PDFWAC 182-400-0300


(1) Compliance. The authority conducts investigations, as needed, to ensure compliance with this chapter.
(2) Investigations. The authority may open an investigation:
(a) When the authority receives information from a carrier that a hospital failed to contract with that carrier to provide in-network coverage to enrollees of the carrier's public option plans after making a valid offer to contract;
(b) When there are no public option plans available in the county where the hospital is located; or
(c) On a case-by-case basis at the authority's sole discretion.
(3) Procedure.
(a) The authority sends a written investigation notice explaining the nature of the allegation to both the hospital and to bidding or contracted carriers.
(b) The authority may request additional information or documentation from the carrier or carriers and the hospital. If the authority sends a written request for information, parties have 30 calendar days to:
(i) Provide the requested information or documentation; or
(ii) Request additional time to complete the request, which the authority may grant on a case-by-case basis.
(c) The authority may request the following information or documentation from any party during an investigation:
(i) A copy of all written communications, including emails, between the hospital and the carriers related to any potential contract offers, or contracts that have been executed related to public option plans and related discussions;
(ii) A copy, including the provider reimbursement rates, of any offer to contract or executed contract;
(iii) A statement from a party explaining the party's position, including information regarding why the offer was not accepted;
(iv) A statement regarding any mitigating factors the hospital or carrier would like the authority to take into consideration when determining whether a sanction is warranted; and
(v) Any other information the authority decides is relevant in determining whether a sanction is appropriate.
(d) If the authority determines that any party has failed to fully and timely respond to the authority's request for information or documentation, the authority may impose an immediate sanction for noncompliance for each incident of noncompliance, as follows:
Number of incidents of noncompliance
Sanction amount
Fourth and subsequent incidents
(e) The authority may issue a sanction for each missing item, or for each failure to provide documentation or information within the required time or may issue sanctions for both. Sanctions under this section are cumulative and immediate but may be stayed if the sanctioned party files an appeal under WAC 182-400-0400.
(f) When issuing an immediate sanction under (d) of this subsection, the authority sends a written notice to demand payment. The authority must receive payment within 28 calendar days of the date the party received the notice.
(4) Sanctions for failure to accept valid contract offer.
(a) After an investigation conducted under subsection (3) of this section, if, in the authority's sole discretion, the authority determines that a hospital failed to accept a valid offer to contract from a carrier, and is not contracted with any other public option plan for that plan year, the sanction amount for that plan year is as follows:
(i) For hospitals with 50 beds or fewer, $182,500; or
(ii) For hospitals with more than 50 beds, $3,650 per bed.
(b) A party may appeal a sanction notice under WAC 182-400-0400.
(5) Public disclosure. The information submitted according to this section is not subject to public disclosure under chapter 42.56 RCW, to the extent set forth in RCW 41.05.410 (3)(b).
[Statutory Authority: RCW 41.05.021, 41.05.160 and 2021 c 246. WSR 22-10-023, ยง 182-400-0300, filed 4/25/22, effective 6/1/22.]
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