WA: OIC releases transparency rule drafts

OLYMPIA — This week the Washington State Office of the Insurance Commissioner (OIC) released two draft regulations regarding health insurance transparency. The first updates a rule filing from last May, requiring annual attestation from health plans that identities their transparency tools provided to members. The second is a newly introduced rule proposal that would add additional transparency requirements for health plan Independent Review Organization (IRO) processes.

Transparency Tool Attestation

R 2015-03 would require health plans to attest at the point of filing or renewing a plan that the transparency tools provided to members fit the following requirements:

(a) Must display cost data for common treatments within the following categories:

(i) In-patient treatments;

(ii) Outpatient treatments;

(iii) Diagnostic tests; and

(iv) Office visits

Additional requirements include:

(c) Are encouraged to display the cost for prescription medications on their member web site or through a link to a third party that manages the prescription benefits;

(d) Must include a patient review option or method for members to provide a rating or feedback on their experience with the medical provider…

(e) Must allow members to access the estimated cost of the treatment, or the total cost of care…on a portable electronic device;

(f) Must display options based on the selected search criteria for members to compare;

(g) Must display the estimated cost of the treatment, or total cost of the care episode, and the estimated out-of-pocket costs of the treatment for the member and display the application of personalized benefits such as deductibles and cost-sharing;

(h) Must display quality information on providers when available; and

(i) Are encouraged to display alternatives that are more cost-effective when there are alternatives available, such as the use of an ambulatory surgical center when one is available or medical versus surgical alternatives as appropriate.

Under the proposed rule, carriers have 30 days after filing or refiling health plans to submit attestations to the OIC. Public comments on the rule will be accepted until September 30th.

Independent Review Organizations

R 2015-12 is intended to improve the transparency of IRO processes and outcomes. IRO’s provide members with the opportunity to request an impartial, external review of a coverage or payment denial by a health plan. While no draft language has been provided, the rule filing states:

This rule-making will consider adding new language to WAC Chapter 284-43 that would require each carrier and health plan to submit final IRO decision determination information to the Office of the Insurance Commissioner’s on-line database within 3 days of receipt of the IRO’s final decision.

Public comments will be accepted until October 2nd.

Engage with health care leaders and policy makers on this and other important issues at the 2015 Inland Northwest State of Reform health policy conference on September 15th.