Provider contract comp.

AN ACT Relating to provider contract compensation; adding a new 1
section to chapter 48.43 RCW; and creating new sections.2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:3
NEW SECTION. Sec. 1. (1) The legislature finds that:4
(a) The costs to operate and maintain a health care practice by 5
health care providers continue to rise and often may exceed consumer 6
price inflation; 7
(b) Significant vertical and horizontal consolidation in health 8
plan markets has given health carriers ever greater bargaining power 9
over individual health care providers and small clinics who have 10
little or no opportunity to meaningfully negotiate compensation to 11
cover overhead costs; 12
(c) Despite increasing costs, many health care professions have 13
experienced no increase in the contracted rates for the health care 14
services provided to carrier enrollees for several years; and15
(d) According to a 2020 American medical association survey, 16
nearly 40 percent of patient care physicians were employed directly 17
by a hospital or a practice owned at least partially by a hospital or 18
health system, an increase from just 23.5 percent in 2012.19
(2) Therefore, the legislature intends to encourage competition 20
and health care market diversity by requiring health carriers to 21
H-0686.1
HOUSE BILL 1655
State of Washington 69th Legislature 2025 Regular Session
By Representatives Stonier, Caldier, and Reed
Read first time 01/28/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1655
annually adjust the compensation offered to health care providers not 1
employed by hospitals or affiliates of hospitals in an amount that 2
reflects inflationary cost increases, thereby deterring the further 3
consolidation in health care delivery markets arising from the 4
abandonment of private practices to employment by hospital systems.5
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 6
RCW to read as follows: 7
(1) For health benefit plans issued or renewed on or after 8
January 1, 2026, compensation provisions in a provider contract 9
between a health care provider not employed by a hospital or any 10
affiliate of a hospital and a health carrier for health care services 11
to enrollees of such health benefit plans must include an increase in 12
compensation from the prior year for health care services that 13
reflects increases in the consumer price index for all urban 14
consumers over the previous year. 15
(2) Nothing in this section requires a provider to accept or 16
reject, or prohibits a provider from accepting or rejecting, a 17
provider contract or an amendment to an existing contract including 18
any increase in compensation required by this section. No provider 19
contract may directly or indirectly waive the requirements of this 20
section and no health carrier may discriminate against any category 21
of provider by excluding or limiting such provider's services in an 22
effort to avoid the compensation provisions of this section.23
(3) This section does not apply to a plan that offers dental only 24
coverage when the plan relies solely on employees of the health 25
carrier for provision of the benefits. 26
(4) For purposes of this section: 27
(a) "Affiliate of a hospital" means related to a hospital in any 28
way by virtue of any form or amount of common ownership, control, 29
operation, or management. 30
(b) "Health benefit plan," in addition to the definition in RCW 31
48.43.005, means vision only coverage offered by a health care 32
service contractor, a limited health care service contractor, or a 33
disability insurer. 34
NEW SECTION. Sec. 3. The insurance commissioner shall adopt 35
rules necessary to implement this act. Such rules shall reflect 36
standards used to determine inflationary increases in the qualifying 37
p. 2 HB 1655
payment amount under the federal no surprises act, 42 U.S.C. Sec. 1
300gg-111, and implementing federal regulations. 2
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p. 3 HB 1655