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New Legislation To Register and Regulate TPAs Proposed in Washington State

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 or 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.

© Polsinelli PC, Polsinelli LLP in California

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About this Author

Steven L. Imber, Polsinelli PC, Insurance Regulatory Attorney, Enforcement Actions Lawyer,
Shareholder

Steve Imber chairs Polsinelli's Insurance Business and Regulatory group.  As a former General Counsel at a state insurance department, Steve Imber has the knowledge and experience to provide quality counsel to insurers, third party administrators, insurance agencies, medical discount plans and other insurance regulated entities. His practice includes representing and assisting clients on multi-state and national licensing projects, research projects, enforcement actions, market conduct examinations, audits and compliance programs and various other regulatory and...

913.234.7469
Shareholder

Justin Liby has a talent for organizing and managing large national and multi-state licensure and research projects. This knack provides him with a solid foundation for crafting and implementing sound, efficient strategies that achieve success for his clients. Justin concentrates his efforts on helping the insurance industry navigate the formidable federal and state regulatory maze to achieve the industry’s business needs. He stays current in the insurance industry's evolution, as well as the legislation and regulatory activity impacting the industry.

Justin is a former regulator for the Kansas Insurance Department and in-house counsel for a national third-party administrator.

913-234-7427
Counsel

Jennifer Osborn Nix works diligently for insurance companies, third-party administrators, and other regulated entities to further their goals and help them remain compliant within the 50-state regulatory scheme. She focuses on insurance regulatory and compliance issues, with a primary emphasis on life and health insurance matters.

Jennifer works with many regulated entities, including many in the health care sector, who rely on her for research, advice, strategic counsel, and licensing.

913.234.7472