State Law

Revised Code of Washington-Title 48-Chapter 48.39. Contracts Between Insurance Carriers, Health Care Providers, and Third-Party Payors

08/28/2023 Washington Section 48.39.020

Payor may require provider to extend payor’s medicaid rates — Limitations

Fee Schedules, Participation in Products, Plans, or Networks, Rental Networks

A payor may require a health care provider to extend the payor’s medicaid rates, or some percentage above the payor’s medicaid rates, that govern a health benefit program administered by a public purchaser to a commercial plan or line of business offered by a payor that is not administered by a public purchaser only if the health care provider has expressly agreed in writing to the extension. For the purposes of this section, “administered by a public purchaser” does not include commercial coverage offered through the Washington health benefit exchange. Nothing in this section prohibits a payor from utilizing medicaid rates, or some percentage above medicaid rates, as a base when negotiating payment rates with a health care provider.