Washington Administrative Code
Title 182 - Health Care Authority
BEHAVIORAL HEALTH
Chapter 182-400 - Public option plans (Cascade care select)
Section 182-400-0300 - Enforcement
Universal Citation: WA Admin Code 182-400-0300
Current through Register Vol. 24-18, September 15, 2024
(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 non-compliance for each incident of
noncompliance, as follows:
|
Number of incidents of noncompliance |
Sanction amount |
|
First |
$10,000 |
|
Second |
$25,000 |
|
Third |
$50,000 |
|
Fourth and subsequent incidents |
$100,000 |
(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).
Disclaimer: These regulations may not be the most recent version. Washington may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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