Health carrier modif. notice

AN ACT Relating to requiring carriers to provide substantive 1
notice to health care providers and health care facilities about 2
significant contract modifications; reenacting and amending RCW 3
41.05.017; adding a new section to chapter 48.43 RCW; and creating a 4
new section. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. The legislature finds that a healthy 7
insurance market requires that major changes to contract terms and 8
expectations between health carriers and providers or facilities be 9
provided in a transparent manner that reflects mutual agreement 10
between the parties. The legislature finds that unilateral changes by 11
health carriers to payment or service delivery through policy changes 12
violate principles of fair contracting and contribute to avoidable 13
contract terminations and changes to access to services for patients. 14
The legislature intends to remedy this by requiring certain policy 15
changes be clearly communicated and mutually agreed upon by the 16
parties before implementation.17
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 18
RCW to read as follows: 19
H-2461.1
HOUSE BILL 2106
State of Washington 69th Legislature 2026 Regular Session
By Representatives Simmons, Valdez, Ryu, Kloba, Doglio, Reed, Obras,
Wylie, Scott, Ormsby, Reeves, Macri, Hill, and Pollet
Prefiled 12/08/25. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
p. 1 HB 2106
(1) A carrier shall provide notice of a significant payer 1
contract modification to the contract representative of the relevant 2
health care provider or health care facility no less than 90 days 3
before the effective date of the significant payer contract 4
modification. This notice must: 5
(a) Specify the precise provider contract to which the 6
significant payer contract modification applies and be conspicuously 7
labeled as "notice of significant payer contract modification to 8
provider contract"; 9
(b) Contain sufficient information about the change to allow the 10
health care provider or health care facility to assess the financial 11
impact, if any, of the significant payer contract modification;12
(c) Include the specific language of the significant payer 13
contract modification; 14
(d) Be sent to the person designated to receive notice under the 15
terms of the relevant provider contract; and 16
(e) Inform the health care provider or health care facility that 17
the provider or facility shall accept or reject the terms of the 18
significant payer contract modification through written or electronic 19
means during the notice period and that a rejection may not affect 20
the terms of the health care provider's or health care facility's 21
existing provider contract with the carrier. 22
(2) A health care provider or health care facility shall 23
affirmatively accept or reject the significant payer contract 24
modification. The rejection of a significant payer contract 25
modification by the health care provider or health care facility may 26
not affect the terms of the existing provider contract.27
(3)(a) If a carrier fails to comply with the requirements of this 28
section, the significant payer contract modification is void.29
(b) If a provider contract contains a provision that violates 30
this section, that provision of the provider contract is void.31
(4) A carrier shall include a summary of all notices of 32
significant payer contract modifications in a single location on the 33
carrier's website and in the carrier's newsletters no less than 90 34
days before the effective date of the significant payer contract 35
modification. 36
(5) For purposes of this section, the following definitions 37
apply: 38
(a)(i) "Significant payer contract modification" means an action 39
by a carrier, whether by policy, guideline, or otherwise, that 40
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results in any of the following changes for a health care provider or 1
health care facility that has a provider contract with the carrier:2
(A) A decrease in fees, payments, or reimbursement to a 3
participating health care provider or health care facility;4
(B) A change in the payment methodology for determining fees, 5
payments, or reimbursement to a participating health care provider or 6
health care provider type including, but not limited to, a new or 7
revised payer coding guideline or payer payment rule;8
(C) A restriction on the site of service for specific services, or 9
changes to payment or coverage based on site of service;10
(D) A new requirement that services be separate or bundled;11
(E) A change to prior authorization, inpatient notification, or 12
claims submission requirements or processes; 13
(F) A restriction or exclusion from the contracted components of 14
service such as provider administered drugs or supplies or a 15
requirement that the contracted component be provided by or purchased 16
from another entity; or 17
(G) A change of procedures that may reasonably be expected to 18
significantly increase a health care provider's administrative 19
expenses. 20
(ii) "Significant payer contract modification" does not include:21
(A) A change required by federal or state law; or22
(B) A change to provide payment policy for new technologies or 23
services that have become available since the provider contract was 24
last negotiated. 25
(b) "Provider contract" has the same meaning as in RCW 48.43.730.26
Sec. 3. RCW 41.05.017 and 2025 c 389 s 3 and 2025 c 171 s 2 are 27
each reenacted and amended to read as follows: 28
Each health plan that provides medical insurance offered under 29
this chapter, including plans created by insuring entities, plans not 30
subject to the provisions of Title 48 RCW, and plans created under 31
RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 32
70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 33
48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 34
48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 35
48.200.300 through 48.200.320, 48.43.440, 48.43.845, 48.43.732, 36
section 2 of this act, and chapter 48.49 RCW. 37
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