HCA gains input from stakeholders on rulemaking for Cascade Care Select plans


Soraya Marashi


On Monday, the Washington State Health Care Authority (HCA) hosted a webinar to provide information on the rulemaking process for mandatory hospital participation in Cascade Care public options plans. 


Stay one step ahead. Join our email list for the latest news.



Lawmakers originally established the state’s public option program in 2019. During the 2021 session, the legislature passed a bill deemed “Cascade Care 2.0,” which, among several provisions, put in place participation requirements for certain hospitals.

The new law states that if a public option is not available in each county during plan year 2022 or later, certain hospitals must contract, if they receive an offer, with at least one public option plan to provide in-network services to enrollees of the plan. Cascade Care 2.0 directs the HCA to establish rulemaking and penalties to ensure hospitals are in compliance.

The webinar was specifically geared toward hospitals, health insurance plans that currently offer Cascade Care, plans that may be interested in the future, and Cascade Care partners including the Washington Health Benefit Exchange (WAHBE) and the Office of the Insurance Commissioner (OIC).

The HCA stated in an announcement: “The goal of HCA’s rulemaking is to address how Cascade Care Select Public Option plans are available in every county, with hospital participation requirements. This webinar will allow us to hear from hospitals, health plan carriers, and others on their concerns, hesitancies, and suggestions.”

The majority of the webinar was dedicated to a Q&A moderated by Policy Communications Manager Rachelle Alongi, who gathered input from stakeholders about hospital participation rulemaking for the 2023 procurement of Cascade Select, which is scheduled to be released in February 2022.

Alongi first asked webinar participants what the HCA should take into consideration when developing rules to enforce hospital contract requirements. Several participants expressed concerns about rate caps and protections for potential conflicts of interest. 

Participants also said it would be helpful if the HCA established clear standards for what exactly is considered an “offer” for a contract from health plans to hospital providers. They said an outcome-based approach to rulemaking, where the HCA would simply check whether or not hospitals have contracted with at least one public option plan, would be the fairest way for the HCA to judge if the requirement has been met, rather than a very detailed approach with extensive guidance and regulatory controls from the HCA.

Additionally, participants raised concerns about hospital participation in cases where a hospital is needed for network adequacy in more than one county.

Alongi then asked participants to identify key barriers for hospitals contracting with a Cascade Select plan, or vice-versa, and how the HCA’s rulemaking could resolve this concern. 

Some participants said negotiated rates may be a barrier, and lower rates may not adequately cover the cost of care. They noted that if the HCA is willing to act as arbitrator in this rate resolution, however, that could be a remedy for this issue.

Participants also mentioned administrative burden, timely payment, and preservation of the continuity of care as barriers to contracting. 

Alongi asked what the HCA should consider when creating rules to ensure compliance with Senate Bill 5377, as the legislature left the HCA’s role in ensuring compliance fairly broad.

One participant said instead of assigning fines for non-compliant hospitals, the HCA should assign administrators to some cases that would more closely assist the hospitals. Other participants suggested a “carrot” approach rather than a “stick” approach by offering supplemental payments for hospitals and networks that experience higher access rates. 

Another webinar participant stated that administrative burdens placed on the hospitals by some of the carriers were significant, and that they frequently received administrative denials for medically necessary services. Alongi responded that she would look into how the HCA could improve this.

“I want to ensure the process that we put together is reasonable and fair and effective. Effective in that it encourages hospitals to contract with select plans.”

One participant asked whether HCA expected to procure additional carriers for the upcoming 2023 procurement and if they planned to increase the coverage service area by contracting with additional carriers. Alongi stated they were still sorting out logistics of the procurement design internally, but that the ultimate goal was providing statewide coverage. 

Finally, Alongi asked the group if the HCA should create an appeals process to allow hospitals to appeal a fine or sanction relating to the failure to contract with at least one Cascade Select plan.

Alongi said she is leaning toward allowing a full appeals process, while most likely using the HCA’s central panel contract with the Office of Administrative Hearings to conduct the annual administrative hearing. 

Other participants suggested a peer review process, as well as a 90-day cure period prior to adjudicative proceedings to look for ways to resolve the issue at a lower level.

Alongi made it clear that the HCA will not assume that the failure to reach a negotiated arrangement is always the hospital’s fault. 

After gathering input for staff rule drafting sessions, stakeholders will have the opportunity to comment on the early draft of the rule once it is ready. The HCA will then review comments on the draft rule, file a CR-102 that includes the proposed rules and hearing date, and hold a public hearing with opportunity for public comment.