Washington state finalizing health insurance plan rules

OLYMPIA – Washington state will soon adopt new rules for next year’s medical insurance plans that some believe will improve patient coverage, but others contend will create significant problems for insurance companies, hospitals and clinics.

The rules are expected to require “timely” service, access to certain specialists, adequate mental health treatment, preventive care programs, and detailed reports on where the doctors and hospitals in their networks are located.

For Insurance Commissioner Mike Kreidler, the rules will help make the different insurance plans being offered in the state easier for consumers to understand.

“I have heard from many consumers exasperated at trying to find which doctors and hospitals are in the networks of this year’s health plans,” Kreidler wrote in a recent guest column defending the new rules.

One goal is to let consumers know whether their doctor and local hospital are in the insurance plan they’re thinking of buying, he said. That’s a particular concern with what are called narrow networks – less-expensive plans with limited networks of doctors and hospitals compared to previous plans a consumer might have had, which included more options and cost more.

But the insurance industry says the changes in state rules that define what they must cover are being rushed. The most recent draft was released in March, and companies must submit their rate plans for next year on May 1.

“They see the rules as unworkable, and setting them up for failure,” said DJ Wilson, the head of a health care strategy firm that operates State of Reform, a blog on health care reform. Among the key areas of concern, he said, are rules for rural health care providers that can require patients to travel to certain specialists, he said. For some rules it’s a distance; for others, it’s a time limit.

“Some of this is really in the weeds. But they could severely disrupt (health care) delivery systems in rural Washington,” Wilson said.

The insurance companies asked for more time, but Kreidler initially was reluctant, saying “doing nothing or delaying is not an option.” Even if they don’t get everything right the first time, the key is protecting consumers, he wrote in the recent guest column.

But Tuesday, the office relented, albeit slightly. The final rules were scheduled to be announced today. But after a hearing Tuesday morning that featured complaints from insurance carriers and others in the health care industry, regulators revised the schedule and said the final rules will be announced late this week or early next.

The staff will take the extra time to study recent comments and could make some adjustments, said Kara Klotz, a spokeswoman for the office. The rules will take effect 31 days after the announcement.

Insurance companies will still have to file their 2015 rates and plans by May 1, Klotz said, but they can make changes to accommodate the new rules through the end of this year.