Definitions; Notice of material amendments to contract — Failure to comply
See bold text below:
Section 48.39.005. Definitions
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) “Health care provider” or “provider” has the same meaning as in RCW 48.43.005 and, for the purposes of this chapter, includes facilities licensed under chapter 70.41 RCW.
(2) “Material amendment” means an amendment to a contract between a payor and health care provider that would result in requiring a health care provider to participate in a health plan, product, or line of business with a lower fee schedule in order to continue to participate in a health plan, product, or line of business with a higher fee schedule. A material amendment does not include any of the following:
(a) A decrease in payment or compensation resulting from a change in a fee schedule published by the payor upon which the payment or compensation is based and the date of applicability is clearly identified in the contract, compensation addendum, or fee schedule notice;
(b) A decrease in payment or compensation that was anticipated under the terms of the contract, if the amount and date of applicability of the decrease is clearly identified in the contract; or
(c) Changes unrelated to compensation so long as reasonable notice of not less than sixty days is provided.
(3) “Payor” or “third-party payor” means carriers licensed under chapters 48.20, 48.21, 48.44, and 48.46 RCW, and managed health care systems as defined in RCW 74.09.522.
Section 48.39.010. Notice of material amendments to contract — Failure to comply
(1) A third-party payor shall provide no less than sixty days’ notice to the health care provider of any proposed material amendments to a health care provider’s contract with the third-party payor.
(2) Any material amendment to a contract must be clearly defined in a notice to the provider from the third-party payor as being a material change to the contract before the provider’s notice period begins. The notice must also inform the providers that they may choose to reject the terms of the proposed material amendment through written or electronic means at any time during the notice period and that such rejection may not affect the terms of the health care provider’s existing contract with the third-party payor.
(3) A health care provider’s rejection of the material amendment does not affect the terms of the health care provider’s existing contract with the third-party payor.
(4) A failure to comply with the terms of subsections (1), (2), and (3) of this section shall void the effectiveness of the material amendment.