Share this e-Alert:

Polsinelli - Insurance Polsinelli - Insurance
         

  

March 2016

  

New Legislation To Register and Regulate TPAs Proposed in Washington State

  

 
 

  

     

  

 
 

For more information about this e-Alert, please contact:

  

Steven L. Imber

Practice Area Chair

913.234.7469

Email | Bio

  

Justin T. Liby

913.234.7427

Email | Bio

  

Jennifer Osborn Nix

913.234.7472

Email | Bio

  

  

To learn more about our Third Party Administrator (TPA) Licensing and Compliance Services, to contact one of our TPA attorneys, or for more TPA Intelligence, click here.

  

  

To learn more about our Insurance Business and Regulatory Law practice, to contact one of our Insurance Business and Regulatory Law Professionals, or for more Intelligence, click here.

  

  


View Polsinelli documents on JD Supra  
LinkedIn Twitter Facebook Polsinelli Podcast

SUBSCRIBE

 

   

Legislation was recently introduced in the Washington State House of Representatives (HB 2445) and the Washington State Senate (SB 6447) that would require third party administrators to register with the Washington Office of Insurance Commissioner (OIC). The proposed legislation was requested by the OIC.

Pursuant to the proposed legislation, a third party administrator will be defined as a person who performs one or more of the following functions on behalf of a carrier in connection with disability, health or stop-loss coverage:

  • Underwriting
  • Collecting charges or premiums
  • Adjusting or settling claims
  • Performing utilization reviews, credentialing providers, granting prior authorization or performing quality audits
  • Acting as a Pharmacy Benefit Manager or Radiology Benefit Manager

In addition to registering with the OIC, the proposed legislation requires carriers to file, with the OIC, at least 30 days before use, all contracts executed between the carrier and TPAs and all contracts between those TPAs and providers. The proposed legislation requires TPAs that contract with a carrier to provide the carrier all contracts executed between the TPA and providers. The contracts are subject to the OIC’s disapproval.

The proposed legislation will also allow the OIC to take the following actions against a TPA that has committed a violation of law:

  • Place on probation, suspend, or revoke the TPA’s license.
  • Issue a fine of up to $5,000 per violation.
  • Issue an order against the TPA or affiliated insurer requiring corrective action.
  • Charge the TPA for costs, fees, and other expenses incurred by the OIC related to any investigation, hearing or court proceeding involving the TPA.

Polsinelli’s TPA team provides legislative monitoring services, TPA licensing services, and a number of other TPA regulatory and compliance services. Our TPA team includes attorneys who were former in-house counsel for TPAs and PBMs, as well as attorneys who were formerly insurance regulators.

Because of our experience with representing TPAs on a multi-state and national basis, we are able to help our clients avoid paying for the “learning curve” incurred by companies or attorneys who are not familiar with TPA regulatory and compliance needs.

For More Information

For additional information regarding this a-Alert, please contact the authors.

 
 

  

     

  

 

 

  

     

  

 
 

Atlanta  Boston  Chattanooga  Chicago  Dallas  Denver  Houston  Kansas City  Los Angeles  Nashville  New York
Overland Park  Phoenix  Raleigh  St. Joseph  St. Louis  San Francisco  Washington, D.C.  Wilmington
polsinelli.com

 
 

  

     

  

 
 

  

ABOUT POLSINELLI

real challenges. real answers.SM  
Polsinelli is an Am Law 100 firm with more than 775 attorneys in 19 offices, serving corporations, institutions, entrepreneurs and individuals nationally. Ranked in the top five percent of law firms for client service*, the firm has risen more than 100 spots in Am Law's annual firm ranking over the past six years. Polsinelli attorneys provide practical legal counsel infused with business insight, and focus on health care and life sciences, financial services, real estate, technology and biotech, mid-market corporate, and business litigation. Polsinelli attorneys have depth of experience in 100 service areas and 70 industries. The firm can be found online at www.polsinelli.com. Polsinelli PC. In California, Polsinelli LLP.

* 2016 BTI Client Service A-Team Report

  

 
 

  

     

  

 
 

Polsinelli provides this material for informational purposes only. The material provided herein is general and is not intended to be legal advice. Polsinelli is very proud of the results we obtain for our clients, but you should know that past results do not guarantee future results; that every case is different and must be judged on its own merits; and that the choice of a lawyer is an important decision and should not be based solely upon advertisements.

Copyright © 2016 Polsinelli PC.

 
 

  

     

  

 
Connect with us on LinkedIn. Connection with us on Twitter. Connect with us on Facebook. Polsinelli Insurance Business and Regulatory Law Insurance Business and Regulatory Law