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Chapter 182-40 WAC

Pebb/Sebb Reimbursement Methodology Requirements

Last update: 12/1/25

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(Effective January 1, 2027)

WAC Sections

GENERAL
HTMLPDF182-40-0100Purpose.
HTMLPDF182-40-0200Definitions.
REIMBURSEMENT REQUIREMENTS AND REPORTING
HTMLPDF182-40-0300Hospital reimbursement requirements.
HTMLPDF182-40-0400Primary care and behavioral health reimbursement requirements.
HTMLPDF182-40-0500Reimbursement using a payment methodology other than fee-for-service.
HTMLPDF182-40-0600Reimbursement benchmarking.
HTMLPDF182-40-0700Reporting requirements.
ENFORCEMENT
HTMLPDF182-40-0800Annual compliance measurement.
HTMLPDF182-40-0900Hospital overpayments.
HTMLPDF182-40-1000Primary care, behavioral health, and critical access hospital underpayments.
HTMLPDF182-40-1100Contractor responsibility for ensuring reimbursement to providers and provider networks.
HTMLPDF182-40-1200Corrective action plan.
HTMLPDF182-40-1300Hospital balance billing.
HTMLPDF182-40-1400Written notice of noncompliance, overpayments, and fines.
HTMLPDF182-40-1500Appeal of notice of noncompliance.