SB6210 • 2026

Health plan certification

Concerning the health plan certification process.

Budget Labor Small Business Taxes

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Senator Slatter, Senator Nobles, Senator Saldaña
Last action: 2026-02-11
Official status: S subst for
Effective date: Not listed

Plain English Breakdown

Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.

Health plan certification

What This Bill Does

Health plan certification

Limits and Unknowns

This entry is temporarily using official source text because the generated explanation could not be confirmed against the official bill text during the last sync.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

6210-S.E AMH APP H3768.1

0 • Appropriations

NOT CONSIDERED

Plain English: 6210-S.E AMH APP H3768.1 ESSB 6210 - H COMM AMD By Committee on Appropriations NOT CONSIDERED 03/12/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.

6210-S.E AMH APP H3768.1 ESSB 6210 - H COMM AMD By Committee on Appropriations NOT CONSIDERED 03/12/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.
Sec.
1.
(1) The legislature finds that: 3 (a) Access to health care is fundamental to the health and safety 4 of Washington state residents; 5 (b) Health insurance coverage is necessary for most people to 6 access health care; 7 (c) Uncertainty in the health insurance marketplace is 8 significantly impacted by the volatility in the federal legislative 9 and regulatory environment; 10 (d) Rising health care costs are impacting access and 11 affordability for Washington state residents; 12 (e) An unstable and volatile individual insurance market would be 13 catastrophic and lead to: 14 (i) Deteriorating health outcomes; 15 (ii) Declining work force productivity; 16 (iii) Lower quality of life; and 17 (iv) Increased burdens on safety net providers from the rising 18 demand for uncompensated care; 19 (f) Each year, the Washington health benefit exchange board uses 20 19 basic criteria that were established in the affordable care act to 21 review and certify health plans that will be offered to Washington 22 state residents in the exchange market; 23 (g) These 19 basic criteria do not address access and 24 affordability issues in the exchange market; and 25 (h) The affordable care act authorizes state exchanges to ensure 26 that certified health plans are in the interest of the residents of 27 the state by adopting additional health plan certification criteria 28 to that effect.

6210-S.E AMH HCW H3659.1

0 • Health Care & Wellness

NOT CONSIDERED

Plain English: 6210-S.E AMH HCW H3659.1 ESSB 6210 - H COMM AMD By Committee on Health Care & Wellness NOT CONSIDERED 03/12/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.

6210-S.E AMH HCW H3659.1 ESSB 6210 - H COMM AMD By Committee on Health Care & Wellness NOT CONSIDERED 03/12/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.
Sec.
1.
(1) The legislature finds that: 3 (a) Access to health care is fundamental to the health and safety 4 of Washington state residents; 5 (b) Health insurance coverage is necessary for most people to 6 access health care; 7 (c) Uncertainty in the health insurance marketplace is 8 significantly impacted by the volatility in the federal legislative 9 and regulatory environment; 10 (d) Rising health care costs are impacting access and 11 affordability for Washington state residents; 12 (e) An unstable and volatile individual insurance market would be 13 catastrophic and lead to: 14 (i) Deteriorating health outcomes; 15 (ii) Declining work force productivity; 16 (iii) Lower quality of life; and 17 (iv) Increased burdens on safety net providers from the rising 18 demand for uncompensated care; 19 (f) Each year, the Washington health benefit exchange board uses 20 19 basic criteria that were established in the affordable care act to 21 review and certify health plans that will be offered to Washington 22 state residents in the exchange market; 23 (g) These 19 basic criteria do not address access and 24 affordability issues in the exchange market; and 25 (h) The affordable care act authorizes state exchanges to ensure 26 that certified health plans are in the interest of the residents of 27 the state by adopting additional health plan certification criteria 28 to that effect.

6210-S.E AMH GRIF WEIK 122

2217 • Griffey

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH GRIF WEIK 122 1 - Official Print By Representative Griffey EFFECT: Expands the listed circumstances in the intent section that are leading to impacts on access and affordability of health care for Washington residents to also include decreasing care options, increasing pharmaceutical costs, an increasingly complicated regulatory environment, and broad-based economic pressures.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH GRIF WEIK 122 1 - Official Print By Representative Griffey EFFECT: Expands the listed circumstances in the intent section that are leading to impacts on access and affordability of health care for Washington residents to also include decreasing care options, increasing pharmaceutical costs, an increasingly complicated regulatory environment, and broad-based economic pressures.
6210-S.E AMH GRIF WEIK 122 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2217 NOT CONSIDERED 03/12/2026 On page 1, line 11 of the striking amendment, after "costs" insert ", decreasing care options, increasing pharmaceutical costs, an increasingly complicated regulatory environment, and broad-based economic pressures" --- END

6210-S.E AMH SCHM WEIK 121

2218 • Schmidt

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH SCHM WEIK 121 1 - Official Print By Representative Schmidt EFFECT: Removes intent language specifying that the nineteen federally required criteria for health plan certification do not address access and affordability issues in the Health Benefit Exchange market.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH SCHM WEIK 121 1 - Official Print By Representative Schmidt EFFECT: Removes intent language specifying that the nineteen federally required criteria for health plan certification do not address access and affordability issues in the Health Benefit Exchange market.
6210-S.E AMH SCHM WEIK 121 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2218 NOT CONSIDERED 03/12/2026 On page 1, line 23 of the striking amendment, after "market;" insert "and" On page 1, line 24 of the striking amendment, after "(g)" strike all material though "(h)" on line 26 --- END

6210-S.E AMH PENN WEIK 139

2219 • Penner

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH PENN WEIK 139 1 - Official Print By Representative Penner EFFECT: Specifies that it is the intent of the Legislature that the Health Benefit Exchange continue to operate as a certifying marketplace and not as an active purchaser of health plans.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH PENN WEIK 139 1 - Official Print By Representative Penner EFFECT: Specifies that it is the intent of the Legislature that the Health Benefit Exchange continue to operate as a certifying marketplace and not as an active purchaser of health plans.
6210-S.E AMH PENN WEIK 139 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2219 NOT CONSIDERED 03/12/2026 On page 2, after line 10 of the striking amendment, insert the following: "(3) It is the intent of the legislature that the Washington health benefit exchange continue to operate as a certifying marketplace and not as an active purchaser of health plans." --- END

6210-S.E AMH ABEL WEIK 124

2220 • Abell

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH ABEL WEIK 124 1 - Official Print By Representative Abell EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by requiring the largest caucus of the House of Representatives to nominate at least one health care provider rather than one employee benefit specialist.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH ABEL WEIK 124 1 - Official Print By Representative Abell EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by requiring the largest caucus of the House of Representatives to nominate at least one health care provider rather than one employee benefit specialist.
6210-S.E AMH ABEL WEIK 124 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2220 NOT CONSIDERED 03/12/2026 On page 2, beginning on line 28 of the striking amendment, after "one" strike "employee benefit specialist" and insert "((employee benefit specialist)) health care provider" --- END

6210-S.E AMH ABEL WEIK 125

2221 • Abell

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH ABEL WEIK 125 1 - Official Print By Representative Abell EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by requiring the second largest caucus of the House of Representatives to nominate at least one actuary rather than one health economist or actuary.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH ABEL WEIK 125 1 - Official Print By Representative Abell EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by requiring the second largest caucus of the House of Representatives to nominate at least one actuary rather than one health economist or actuary.
6210-S.E AMH ABEL WEIK 125 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2221 NOT CONSIDERED 03/12/2026 On page 2, line 31 of the striking amendment, after "one" strike "health economist or" and insert "((health economist or))" --- END

6210-S.E AMH BURN WEIK 126

2222 • Burnett

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH BURN WEIK 126 1 - Official Print By Representative Burnett EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by specifying that the second largest caucus of the Senate's nomination of at least one representative of small business must be a representative of small business headquartered in Washington.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH BURN WEIK 126 1 - Official Print By Representative Burnett EFFECT: Modifies the nominations for members of the Health Benefit Exchange Board by specifying that the second largest caucus of the Senate's nomination of at least one representative of small business must be a representative of small business headquartered in Washington.
6210-S.E AMH BURN WEIK 126 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2222 NOT CONSIDERED 03/12/2026 On page 2, line 36 of the striking amendment, after "business" insert "headquartered within the State of Washington" --- END

6210-S.E AMH RUDE WEIK 123

2223 • Rude

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH RUDE WEIK 123 1 - Official Print By Representative Rude EFFECT: Modifies the experience and expertise requirements for some of the nominees for members of the Health Benefit Exchange Board so that the nominees must have demonstrated experience and acknowledged expertise in at least one of the following fields: Health carrier operations, health plan administration, provider network development, federal health policy, public finance, IT and digital platforms, or data and quality measurement (rather than individual health coverage, small employer health care coverage, health plan administration, health care finance and economics, actuarial sciences, or administering a public or private health care delivery system).

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH RUDE WEIK 123 1 - Official Print By Representative Rude EFFECT: Modifies the experience and expertise requirements for some of the nominees for members of the Health Benefit Exchange Board so that the nominees must have demonstrated experience and acknowledged expertise in at least one of the following fields: Health carrier operations, health plan administration, provider network development, federal health policy, public finance, IT and digital platforms, or data and quality measurement (rather than individual health coverage, small employer health care coverage, health plan administration, health care finance and economics, actuarial sciences, or administering a public or private health care delivery system).
6210-S.E AMH RUDE WEIK 123 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2223 NOT CONSIDERED 03/12/2026 On page 2, at the beginning of line 39 of the striking amendment, beginning with "Individual" strike all material through "system" on page 3, line 3 and insert "((Individual health care coverage, small employer health care coverage, health benefit plan administration, health care finance and economics, actuarial science, or administering a public or private health care delivery system)) Health carrier operations, health plan administration, provider network development, federal health policy, public finance, IT and digital platforms, or data and quality measurement" --- END

6210-S.E AMH MARS WEIK 127

2224 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 127 1 - Official Print By Representative Marshall EFFECT: Extends the term of the Health Benefit Exchange Board members from two years to three years and establishes a term limit of two terms.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 127 1 - Official Print By Representative Marshall EFFECT: Extends the term of the Health Benefit Exchange Board members from two years to three years and establishes a term limit of two terms.
6210-S.E AMH MARS WEIK 127 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2224 NOT CONSIDERED 03/12/2026 On page 3, beginning on line 29 of the striking amendment, after "serve" strike "two-year terms" and insert "((two-year)) three-year terms for up to a total of no more than six years consecutively.
Board members may take a one-term break and return to the board for one additional term" --- END

6210-S.E AMH MARS WEIK 128

2225 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 128 1 - Official Print By Representative Marshall EFFECT: Removes reimbursement for official business travel expenses for Health Benefit Exchange Board members.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 128 1 - Official Print By Representative Marshall EFFECT: Removes reimbursement for official business travel expenses for Health Benefit Exchange Board members.
6210-S.E AMH MARS WEIK 128 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2225 NOT CONSIDERED 03/12/2026 On page 4, line 9 of the striking amendment, after "board" strike "must" and insert "((must)) will not" On page 4, beginning on line 10 of the striking amendment, after "business" strike all material through "43.03.060" on line 11 and insert "((in accordance with RCW 43.03.050 and 43.03.060))" --- END

6210-S.E AMH MARS WEIK 133

2226 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 133 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 133 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2226 NOT CONSIDERED 03/12/2026 On page 7, line 10 of the striking amendment, after "By" strike "November" and insert "June" On page 7, line 20 of the striking amendment, after "after" strike "November" and insert "June" On page 7, line 24 of the striking amendment, after "By" strike "December" and insert "June" On page 7, line 32 of the striking amendment, after "By" strike "January 15th of the calendar year" and insert "August 15th of the calendar year two years" On page 7, line 36 of the striking amendment, after "By" strike "January 31st of the calendar year" and insert "October 31st of the calendar year two years" On page 8, line 1 of the striking amendment, after "By" strike "January 31st of the calendar year" and insert "October 31st of the calendar year two years" On page 8, line 19 of the striking amendment, after "By" strike "March 1st of the calendar year" and insert "December 1st of the calendar year two years" On page 8, line 33 of the striking amendment, after "After" strike "March" and insert "February" 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 6210-S.E AMH MARS WEIK 133 2 - Official Print EFFECT: Modifies the timeline in which the Health Benefit Exchange (Exchange) and others must perform certain tasks as follows:  the deadline to identify any known market conditions that may impact access and affordability in the Exchange market for the upcoming plan year and to develop and submit a market conditions assessment report is moved from November 1st of the calendar year two years before, to June 1st of the calendar year two years before, the plan year in which the market factor certification criteria would apply;  the deadline to identify preliminary criteria and provide the criteria to the Insurance Commissioner, the Governor, and others is moved from December 15th of the calendar year two years before, to June 15th of the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Insurance Commissioner and Governor to provide written objections to any preliminary criteria is moved from January 15th of the calendar year before, to August 15th the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Exchange to provide a written response to any objection, explain how the objection was addressed, and to publish notice of the preliminary criteria is moved from January 31st the calendar year before, to October 31st the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Exchange to provide notice of the final criteria is moved from March 1st the calendar year before, to December 1st of the calendar year two years before, the plan year in which the criteria would apply; and  the prohibition on the Exchange modifying the criteria, except as necessary to respond to applicable changes to state or federal laws or regulations, is moved to February 1st (from March 1st) of the calendar year before the plan year in which the criteria would apply.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 133 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 133 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2226 NOT CONSIDERED 03/12/2026 On page 7, line 10 of the striking amendment, after "By" strike "November" and insert "June" On page 7, line 20 of the striking amendment, after "after" strike "November" and insert "June" On page 7, line 24 of the striking amendment, after "By" strike "December" and insert "June" On page 7, line 32 of the striking amendment, after "By" strike "January 15th of the calendar year" and insert "August 15th of the calendar year two years" On page 7, line 36 of the striking amendment, after "By" strike "January 31st of the calendar year" and insert "October 31st of the calendar year two years" On page 8, line 1 of the striking amendment, after "By" strike "January 31st of the calendar year" and insert "October 31st of the calendar year two years" On page 8, line 19 of the striking amendment, after "By" strike "March 1st of the calendar year" and insert "December 1st of the calendar year two years" On page 8, line 33 of the striking amendment, after "After" strike "March" and insert "February" 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 6210-S.E AMH MARS WEIK 133 2 - Official Print EFFECT: Modifies the timeline in which the Health Benefit Exchange (Exchange) and others must perform certain tasks as follows:  the deadline to identify any known market conditions that may impact access and affordability in the Exchange market for the upcoming plan year and to develop and submit a market conditions assessment report is moved from November 1st of the calendar year two years before, to June 1st of the calendar year two years before, the plan year in which the market factor certification criteria would apply;  the deadline to identify preliminary criteria and provide the criteria to the Insurance Commissioner, the Governor, and others is moved from December 15th of the calendar year two years before, to June 15th of the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Insurance Commissioner and Governor to provide written objections to any preliminary criteria is moved from January 15th of the calendar year before, to August 15th the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Exchange to provide a written response to any objection, explain how the objection was addressed, and to publish notice of the preliminary criteria is moved from January 31st the calendar year before, to October 31st the calendar year two years before, the plan year in which the criteria would apply;  the deadline for the Exchange to provide notice of the final criteria is moved from March 1st the calendar year before, to December 1st of the calendar year two years before, the plan year in which the criteria would apply; and  the prohibition on the Exchange modifying the criteria, except as necessary to respond to applicable changes to state or federal laws or regulations, is moved to February 1st (from March 1st) of the calendar year before the plan year in which the criteria would apply.
END

6210-S.E AMH MARS WEIK 144

2494 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 144 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange (Exchange) from adopting additional market factor certification criteria (criteria) beginning with plan year 2030, unless the proposed criteria are accompanied by: a fiscal impact analysis conducted by the Office of the Insurance Commissioner and the Health Care Authority; a stakeholder work group that includes all carriers offering health plans through the Exchange market; and an implementation timeline of no less than 13 months from proposed preliminary criteria to the effective date of the criteria.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 144 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange (Exchange) from adopting additional market factor certification criteria (criteria) beginning with plan year 2030, unless the proposed criteria are accompanied by: a fiscal impact analysis conducted by the Office of the Insurance Commissioner and the Health Care Authority; a stakeholder work group that includes all carriers offering health plans through the Exchange market; and an implementation timeline of no less than 13 months from proposed preliminary criteria to the effective date of the criteria.
6210-S.E AMH MARS WEIK 144 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2494 NOT CONSIDERED 03/12/2026 On page 9, line 1 of the striking amendment, after "(6)" insert "The exchange may not adopt additional market factor certification criteria beginning with plan year 2030 unless the proposed market factor certification criteria are accompanied by: (a) A fiscal impact analysis conducted jointly with the office of the insurance commissioner and the health care authority; (b) A stakeholder workgroup including all carriers offering qualified health plans through the exchange market; and (c) An implementation timeline of no less than 13 months from proposed preliminary market factor certification criteria to the effective date of the final criteria.
(7)" Renumber the remaining subsections consecutively and correct any internal references accordingly.
END

6210-S.E AMH MARS WEIK 143

2495 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 143 1 - Official Print By Representative Marshall EFFECT: Requires the Health Benefit Exchange to approve any waiver of the market factor certification criteria requested by a health carrier.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 143 1 - Official Print By Representative Marshall EFFECT: Requires the Health Benefit Exchange to approve any waiver of the market factor certification criteria requested by a health carrier.
6210-S.E AMH MARS WEIK 143 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2495 NOT CONSIDERED 03/12/2026 On page 9, beginning on line 15 of the striking amendment, after "(c)" strike all material through "commissioner" on line 34 and insert "Any waiver request must be approved by the Exchange" --- END

6210-S.E AMH MARS WEIK 142

2496 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 142 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 142 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2496 NOT CONSIDERED 03/12/2026 On page 11, after line 20 of the striking amendment, insert the following: "Sec.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 142 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 142 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2496 NOT CONSIDERED 03/12/2026 On page 11, after line 20 of the striking amendment, insert the following: "Sec.
6.
RCW 43.71.095 and 2021 c 246 s 7 are each amended to read as follows: (1) The exchange, in consultation with the commissioner, the authority, an independent actuary, and other stakeholders, must establish up to three standardized health plans for each of the bronze, silver, and gold levels.
(a) The standardized health plans must be designed to reduce deductibles, make more services available before the deductible, provide predictable cost sharing, maximize subsidies, limit adverse premium impacts, reduce barriers to maintaining and improving health, and encourage choice based on value, while limiting increases in health plan premium rates.

6210-S.E AMH MARS WEIK 141

2497 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 141 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 141 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2497 NOT CONSIDERED 03/12/2026 On page 11, after line 20 of the striking amendment, insert the following: "Sec.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 141 1 - Official Print By Representative Marshall 6210-S.E AMH MARS WEIK 141 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2497 NOT CONSIDERED 03/12/2026 On page 11, after line 20 of the striking amendment, insert the following: "Sec.
6.
RCW 43.71.095 and 2021 c 246 s 7 are each amended to read as follows: (1) The exchange, in consultation with the commissioner, the authority, an independent actuary, and other stakeholders, must establish up to three standardized health plans for each of the ((bronze,)) silver((,)) and gold levels.
(a) The standardized health plans must be designed to reduce deductibles, make more services available before the deductible, provide predictable cost sharing, maximize subsidies, limit adverse premium impacts, reduce barriers to maintaining and improving health, and encourage choice based on value, while limiting increases in health plan premium rates.

6210-S.E AMH MARS WEIK 140

2498 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 140 1 - Official Print By Representative Marshall EFFECT: Expires the act immediately if H.R.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 140 1 - Official Print By Representative Marshall EFFECT: Expires the act immediately if H.R.
1 is repealed.
6210-S.E AMH MARS WEIK 140 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2498 NOT CONSIDERED 03/12/2026 On page 11, line 30 of the striking amendment, after "delivery." insert the following: "NEW SECTION.
Sec.

6210-S.E AMH MARS WEIK 138

2499 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 138 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange from determining which carriers may offer health plans on the Exchange and which carriers may not offer health plans on the Exchange, if the Exchange determines two health plans are not meaningfully different and if all federally required criteria are met.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 138 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange from determining which carriers may offer health plans on the Exchange and which carriers may not offer health plans on the Exchange, if the Exchange determines two health plans are not meaningfully different and if all federally required criteria are met.
6210-S.E AMH MARS WEIK 138 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2499 NOT CONSIDERED 03/12/2026 On page 9, line 35 of the striking amendment, after "(8)" insert "If the exchange determines that two health plans are not meaningfully different, the exchange may not determine which carriers may offer health plans on the exchange and which carriers may not offer health plans on the exchange, if all federally required criteria are met.
(9)" Renumber the remaining subsections consecutively and correct any internal references accordingly.
END

6210-S.E AMH MARS WEIK 129

2500 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 129 1 - Official Print By Representative Marshall EFFECT: Removes the authority for the Health Benefit Exchange to adopt market factor certification criteria.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 129 1 - Official Print By Representative Marshall EFFECT: Removes the authority for the Health Benefit Exchange to adopt market factor certification criteria.
6210-S.E AMH MARS WEIK 129 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2500 NOT CONSIDERED 03/12/2026 On page 4, beginning on line 37 of the striking amendment, strike all of sections 3 and 4 Renumber the remaining sections consecutively and correct any internal references accordingly.
END

6210-S.E AMH MARS WEIK 130

2501 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 130 1 - Official Print By Representative Marshall EFFECT: Replaces the existing definition of "meaningfully different" with the following definition: a quantifiable distinction between qualified health plans offered by a carrier on the Health Benefit Exchange (Exchange) market based solely on actuarial value and cost‑ sharing parameters, premium price differentials, and network adequacy measures as required by the Office of the Insurance Commissioner.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 130 1 - Official Print By Representative Marshall EFFECT: Replaces the existing definition of "meaningfully different" with the following definition: a quantifiable distinction between qualified health plans offered by a carrier on the Health Benefit Exchange (Exchange) market based solely on actuarial value and cost‑ sharing parameters, premium price differentials, and network adequacy measures as required by the Office of the Insurance Commissioner.
Prohibits the Exchange from defining meaningfully different to include subjective, qualitative, or discretionary factors, and from adopting criteria that would require carriers to create new provider networks; modify benefit structures outside actuarial value parameters mandated by state or federal law; withdraw from rating areas; or add rating areas.
6210-S.E AMH MARS WEIK 130 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2501 NOT CONSIDERED 03/12/2026 On page 11, line 11 of the striking amendment, after "(13)" insert "(a)" On page 11, beginning on line 12 of the striking amendment, beginning with "there" strike all material through "exchange" on line 14 and insert "a quantifiable distinction between qualified health plans offered by a carrier on the exchange market based solely on actuarial value and cost‑ sharing parameters, premium price differentials, and network adequacy measures as required by the office of the insurance commissioner.
(b) The exchange may not define “meaningfully different” to include subjective, qualitative, or discretionary factors, nor may it adopt criteria that would require carriers to: (i) Create new provider networks; (ii) Modify benefit structures outside actuarial value parameters mandated by federal or state law; (iii) Withdraw from rating areas; or (iv) Add rating areas" 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 6210-S.E AMH MARS WEIK 130 2 - Official Print --- END

6210-S.E AMH MARS WEIK 131

2502 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 131 1 - Official Print By Representative Marshall EFFECT: Modifies the authority for the Health Benefit Exchange (Exchange) to adopt market factor certification criteria by limiting the Exchange to adopting new criteria every two years (rather than every year) that will apply to the next two plan years.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 131 1 - Official Print By Representative Marshall EFFECT: Modifies the authority for the Health Benefit Exchange (Exchange) to adopt market factor certification criteria by limiting the Exchange to adopting new criteria every two years (rather than every year) that will apply to the next two plan years.
6210-S.E AMH MARS WEIK 131 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2502 NOT CONSIDERED 03/12/2026 On page 5, line 35 of the striking amendment, after "(1)" strike "Each year" and insert "Beginning in 2026 for plan year 2028 and every two years thereafter" On page 6, line 1 of the striking amendment, after "(2)" strike "Each year" and insert "Beginning with plan year 2028 and every two years thereafter" On page 6, line 2 of the striking amendment, after "the" strike "upcoming plan year" and insert "next two plan years" On page 7, line 8 of the striking amendment, after "developed" insert "every two years" --- END

6210-S.E AMH MARS WEIK 134

2503 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 134 1 - Official Print By Representative Marshall EFFECT: Requires the Health Benefit Exchange to hold at least two public hearings (rather than one), no later than ten days before publication of the final market factor certification criteria (rather than seven days).

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 134 1 - Official Print By Representative Marshall EFFECT: Requires the Health Benefit Exchange to hold at least two public hearings (rather than one), no later than ten days before publication of the final market factor certification criteria (rather than seven days).
6210-S.E AMH MARS WEIK 134 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2503 NOT CONSIDERED 03/12/2026 On page 8, line 16 of the striking amendment, after "than" strike "seven" and insert "ten" On page 8, line 18 of the striking amendment, after "least" strike "one" and insert "two" --- END

6210-S.E AMH MARS WEIK 135

2504 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 135 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange from modifying the market factor certification criteria (criteria) after March first of the calendar year before the plan year in which the criteria would apply.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 135 1 - Official Print By Representative Marshall EFFECT: Prohibits the Health Benefit Exchange from modifying the market factor certification criteria (criteria) after March first of the calendar year before the plan year in which the criteria would apply.
6210-S.E AMH MARS WEIK 135 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2504 NOT CONSIDERED 03/12/2026 On page 8, beginning on line 35 of the striking amendment, after "may" strike all material through "commissioner" on line 39 and insert "not modify the market factor certification criteria" --- END

6210-S.E AMH MARS WEIK 136

2505 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 136 1 - Official Print By Representative Marshall EFFECT: Modifies the authority for the Health Benefit Exchange (Exchange) to require carriers seeking to offer qualified health plans on the Exchange market to submit certain information by modifying the timeline for carriers to provide the information, so that carriers must submit the information at a date determined by the Exchange, no earlier than April 1st and no later than May 1st each year, rather than no earlier than March 1st and no later than May 1st.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 136 1 - Official Print By Representative Marshall EFFECT: Modifies the authority for the Health Benefit Exchange (Exchange) to require carriers seeking to offer qualified health plans on the Exchange market to submit certain information by modifying the timeline for carriers to provide the information, so that carriers must submit the information at a date determined by the Exchange, no earlier than April 1st and no later than May 1st each year, rather than no earlier than March 1st and no later than May 1st.
6210-S.E AMH MARS WEIK 136 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2505 NOT CONSIDERED 03/12/2026 On page 9, line 6 of the striking amendment, after "earlier than" strike "March" and insert "April" --- END

6210-S.E AMH MARS WEIK 137

2506 • Marshall

NOT CONSIDERED

Plain English: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 137 1 - Official Print By Representative Marshall EFFECT: Modifies the timing for when a health carrier may request a waiver from the market factor certification criteria (criteria) so that the Health Benefit Exchange may choose a date that will be no earlier than April 1st rather than March 1st.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 6210-S.E AMH MARS WEIK 137 1 - Official Print By Representative Marshall EFFECT: Modifies the timing for when a health carrier may request a waiver from the market factor certification criteria (criteria) so that the Health Benefit Exchange may choose a date that will be no earlier than April 1st rather than March 1st.
Removes the Health Benefit Exchange's authority to request that the carrier submit information about service areas that would be in place with the criteria and if the waiver were granted, when evaluating the request for a waiver.
6210-S.E AMH MARS WEIK 137 ESSB 6210 - H AMD TO APP COMM AMD (H-3768.1/26) 2506 NOT CONSIDERED 03/12/2026 On page 9, line 12 of the striking amendment, after "earlier than" strike "March" and insert "April" On page 9, line 23 of the striking amendment, after "areas;" insert "and" On page 9, beginning on line 24 of the striking amendment, after "(ii)" strike all material through "(iii)" on line 27 --- END

6210-S AMS SLAT S5004.1

583 • Slatter

ADOPTED

Plain English: 6210-S AMS SLAT S5004.1 SSB 6210 - S AMD 583 By Senator Slatter ADOPTED 02/11/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.

6210-S AMS SLAT S5004.1 SSB 6210 - S AMD 583 By Senator Slatter ADOPTED 02/11/2026 Strike everything after the enacting clause and insert the 1 following: 2 "NEW SECTION.
Sec.
1.
(1) The legislature finds that: 3 (a) Access to health care is fundamental to the health and safety 4 of Washington state residents; 5 (b) Health insurance coverage is necessary for most people to 6 access health care; 7 (c) Uncertainty in the health insurance marketplace is 8 significantly impacted by the volatility in the federal legislative 9 and regulatory environment; 10 (d) Rising health care costs are impacting access and 11 affordability for Washington state residents; 12 (e) An unstable and volatile individual insurance market would be 13 catastrophic and lead to: 14 (i) Deteriorating health outcomes; 15 (ii) Declining work force productivity; 16 (iii) Lower quality of life; and 17 (iv) Increased burdens on safety net providers from the rising 18 demand for uncompensated care; 19 (f) Each year, the Washington health benefit exchange board uses 20 19 basic criteria that were established in the affordable care act to 21 review and certify health plans that will be offered to Washington 22 state residents in the exchange market; 23 (g) These 19 basic criteria do not address access and 24 affordability issues in the exchange market; and 25 (h) The affordable care act authorizes state exchanges to ensure 26 that certified health plans are in the interest of the residents of 27 the state by adopting additional health plan certification criteria 28 to that effect.

Bill History

2026-02-11 Senate
1st substitute bill substituted.

Official Summary Text

Health plan certification

Current Bill Text

Read the full stored bill text

AN ACT Relating to safeguarding access and affordability for 1
exchange customers through the health plan certification process; 2
amending RCW 43.71.065; adding a new section to chapter 43.71 RCW; 3
adding a new section to chapter 42.56 RCW; creating a new section; 4
and declaring an emergency. 5
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:6
NEW SECTION. Sec. 1. (1) The legislature finds that: 7
(a) Access to health care is fundamental to the health and safety 8
of Washington state residents; 9
(b) Health insurance coverage is necessary for most people to 10
access health care; 11
(c) Uncertainty in the health insurance marketplace is 12
significantly impacted by the volatility in the federal legislative 13
and regulatory environment; 14
(d) Rising health care costs are impacting access and 15
affordability for Washington state residents; 16
(e) An unstable and volatile individual insurance market would be 17
catastrophic and lead to: 18
(i) Deteriorating health outcomes; 19
(ii) Declining work force productivity; 20
(iii) Lower quality of life; and 21
S-3986.1
SENATE BILL 6210
State of Washington 69th Legislature 2026 Regular Session
By Senators Slatter, Nobles, and Saldaña
Read first time 01/19/26. Referred to Committee on Health & Long-
Term Care.
p. 1 SB 6210
(iv) Increased burdens on safety net providers from the rising 1
demand for uncompensated care; 2
(f) Each year, the Washington health benefit exchange board uses 3
19 basic criteria that were established in the affordable care act to 4
review and certify health plans that will be offered to Washington 5
state residents in the exchange market; 6
(g) These 19 basic criteria do not address access and 7
affordability issues in the exchange market; and 8
(h) The affordable care act authorizes state exchanges to ensure 9
that certified health plans are in the interest of the residents of 10
the state by adopting additional health plan certification criteria 11
to that effect. Access to and affordability of health plans are in 12
the interest of residents of the state. 13
(2) Therefore, the legislature intends to authorize the 14
Washington health benefit exchange to add criteria in the health plan 15
certification process to address access and affordability issues 16
impacting residents who purchase health insurance coverage on the 17
exchange market and help reduce volatility in the exchange market.18
Sec. 2. RCW 43.71.065 and 2018 c 44 s 5 are each amended to read 19
as follows: 20
(1) The board shall certify a plan as a qualified health plan to 21
be offered through the exchange if the plan is determined by the:22
(a) Insurance commissioner to meet the requirements of Title 48 23
RCW and rules adopted by the commissioner pursuant to chapter 34.05 24
RCW to implement the requirements of Title 48 RCW;25
(b) Board to meet the requirements of applicable federal law for 26
certification as a qualified health plan; ((and))27
(c) Board to meet the market factor criteria that address access 28
and affordability as established in section 3 of this act; and29
(d) Board to include tribal clinics and urban Indian clinics as 30
essential community providers in the plan's provider network 31
consistent with federal law. If consistent with federal law, 32
integrated delivery systems shall be exempt from the requirement to 33
include essential community providers in the provider network.34
(2) Consistent with applicable federal law, the board shall allow 35
stand-alone dental plans to offer coverage in the exchange beginning 36
January 1, 2014. Dental benefits offered in the exchange must be 37
offered and priced separately to assure transparency for consumers.38
p. 2 SB 6210
(3) The board may permit direct primary care medical home plans, 1
consistent with applicable federal law, to be offered in the 2
exchange. 3
(4) Upon request by the board, a state agency shall provide 4
information to the board for its use in determining if the 5
requirements under subsection (1)(b) or (c) of this section have been 6
met. Unless the agency and the board agree to a later date, the 7
agency shall provide the information within sixty days of the 8
request. The exchange shall reimburse the agency for the cost of 9
compiling and providing the requested information within one hundred 10
eighty days of its receipt. 11
(5) A decision by the board denying a request to certify or 12
recertify a plan as a qualified health plan may be appealed according 13
to procedures adopted by the board. 14
NEW SECTION. Sec. 3. A new section is added to chapter 43.71 15
RCW to read as follows: 16
(1) Each year, after the board has reviewed and certified health 17
plans to be offered on the exchange market in the following plan 18
year, the exchange shall review market conditions and identify access 19
and affordability issues in the exchange market that impact the next 20
plan year for which the exchange has not yet certified plans.21
(2) Each year, the exchange may adopt market factor certification 22
criteria for the next plan year to address market conditions that 23
impact access to and affordability of health plans for individuals or 24
employers who are eligible to purchase coverage on the exchange 25
market in Washington state. When developing the criteria, the 26
exchange may consider whether health plans available in each county 27
are: 28
(a) Meaningfully different with respect to a combination of or 29
all of these measures, as determined by the exchange:30
(i) Cost-sharing; 31
(ii) Covered benefits; 32
(iii) Premiums; 33
(iv) Provider networks; or 34
(v) Quality; 35
(b) Offered by more than one carrier; 36
(c) Maximizing federal premium tax credits; 37
(d) Efficiently utilizing state premium assistance and other 38
state investments; and 39
p. 3 SB 6210
(e) Offered at each metal level required by the exchange.1
(3) Market factor certification criteria shall be developed in 2
consultation with the commissioner and the authority, and the 3
exchange shall consider comments from: 4
(a) Carriers that offer or seek to offer qualified health plans 5
on the exchange in the state; 6
(b) Federally recognized tribes in the state through the American 7
Indian health commission; and 8
(c) Other health care stakeholders through their statewide 9
associations or organizations. 10
(4)(a) For plan year 2028 and later, market factor certification 11
criteria shall be developed in accordance with the following 12
timeline: 13
(i) By December 15th of the calendar year two years before the 14
plan year in which the market factor certification criteria are to 15
apply, the exchange shall identify preliminary criteria and provide 16
those criteria to the commissioner and the governor;17
(ii) By January 15th of the calendar year before the plan year in 18
which the market factor certification criteria are to apply, the 19
commissioner and the governor may submit to the exchange a written 20
objection to any of the preliminary criteria; 21
(iii) By January 31st of the calendar year before the plan year 22
in which the market factor certification criteria are to apply, the 23
exchange shall provide a written response to any objection, including 24
whether and how the objection was addressed and what criteria were 25
amended or removed based on the objection; 26
(iv) By January 31st of the calendar year before the plan year in 27
which the market factor certification criteria are to apply, the 28
exchange shall publish the notice of the proposed market factor 29
certification criteria on the exchange website and distribute the 30
notice electronically to any person requesting the notice. The notice 31
shall include: 32
(A) An explanation of the proposed market factor certification 33
criteria; 34
(B) The time, date, and place for a public hearing; and35
(C) The procedures and timelines for submitting written comments 36
and supporting information; 37
(v) No later than five business days before the publication of 38
the final market factor certification criteria, the exchange shall 39
hold at least one public hearing; 40
p. 4 SB 6210
(vi) By March 1st of the calendar year before the plan year in 1
which the market factor certification criteria are to apply, the 2
exchange shall provide written notice of the final market factor 3
certification criteria to carriers that offer health plans subject to 4
certification under RCW 43.71.065, and shall publish the notice of 5
the final market factor certification criteria on the exchange 6
website and distribute the notice electronically to any person 7
requesting the notice; 8
(vii) After March 1st of the calendar year before the plan year 9
in which the market factor certification criteria are to apply, the 10
exchange may only modify the market factor certification criteria as 11
necessary to respond to any applicable changes to state or federal 12
laws or regulations. Any modification initiated under this subsection 13
that impacts a carrier's preliminary health plan filings is only in 14
effect if agreed to by the commissioner. 15
(b) For plan year 2027, market factor certification criteria 16
shall be developed in accordance with procedures established by the 17
exchange. 18
(5)(a) The exchange may require a carrier that is intending to 19
offer health plans on the exchange to submit information, including 20
the carrier's proposed service areas, proposed plan offerings and 21
rates on the exchange, and how the carrier intends to meet the market 22
factor certification criteria. 23
(b) No earlier than March 1st and no later than May 1st each 24
year, the carrier shall provide the information to the exchange. The 25
specific date must be determined by the exchange before March 1st.26
(6)(a) A carrier may request a waiver of the market factor 27
certification criteria. 28
(b) Requests for a waiver must be submitted to the exchange at a 29
date specified by the exchange but will be no earlier than March 1st 30
and no later than 14 days prior to the deadline established by the 31
commissioner each year for preliminary health plans filings.32
(c) In evaluating a request for a waiver, the exchange may:33
(i) Review information that demonstrates the carrier attempted to 34
meet the market factor certification criteria, such as information 35
that the carrier made a good faith effort to contract with providers 36
to establish an adequate network, the cost of the potential provider 37
network, impact on premiums, legal prohibitions, or other barriers 38
that impact the carrier's ability to offer coverage in certain 39
service areas, and any impact on other service areas;40
p. 5 SB 6210
(ii) Request that the carrier submit information about service 1
areas and rates that would be in place with the market factor 2
certification criteria and if the waiver were granted;3
(iii) Consider the totality of the proposed health plans and the 4
impact of granting or not granting the waiver of the market factor 5
certification criteria on the interests of Washington state 6
residents. 7
(d) The exchange shall conclude any waiver determinations 8
regarding market factor certification criteria from any carrier that 9
has requested a waiver prior to the carrier submitting preliminary 10
health plan filings for the upcoming plan year to the commissioner.11
(7) Any information and data submitted by a carrier to the 12
exchange under this section is confidential and not subject to public 13
disclosure under chapter 42.56 RCW. 14
(8) Market factor certification criteria may not directly impose 15
network participation requirements or reimbursement limits on 16
hospitals or providers except as otherwise required by federal or 17
state laws. 18
(9) Nothing in this section prohibits a carrier from offering a 19
health plan that does not meet the requirements in RCW 43.71.065 in 20
the individual market or small group market outside the exchange.21
NEW SECTION. Sec. 4. A new section is added to chapter 42.56 22
RCW to read as follows: 23
Any information or data submitted by a carrier to the health 24
benefit exchange for the purposes of the market factor certification 25
criteria under section 3 of this act are confidential and exempt from 26
disclosure under this chapter. 27
NEW SECTION. Sec. 5. This act is necessary for the immediate 28
preservation of the public peace, health, or safety, or support of 29
the state government and its existing public institutions, and takes 30
effect immediately.31
--- END ---
p. 6 SB 6210