Around the PIA Western Alliance States – Week of November 11, 2024

Washington — Simplification activities: Effective January 1, 2025, the Foundation for Healthcare Quality will be assuming the role of Lead Organization for Administrative Simplification in Washington State.

In 2000, “Admin Simp” was created by the Washington Healthcare Forum to make it easier for payors and providers to do business together. In 2009, the Legislature directed the OIC to designate a private sector organization to serve as the Lead Organization for Administrative Simplification in Washington State. The OIC designated OneHealthPort and the Forum to serve in the Lead Organization capacity.

Much of the important work that OneHealthPort has been doing over the past years will be housed within a successor organization. The OIC and the Forum have a strong commitment to sustaining our state’s administrative simplification efforts. To that end, the OIC and the Forum worked collaboratively to select the Foundation for Healthcare Quality to assume the Lead Organization role.

The Foundation for Healthcare Quality is a nonprofit organization located in Seattle, WA whose mission is to catalyze system-wide quality improvement by letting those who give, get, and pay for care lead the way within a framework driven by meaningful clinical data, collaboration, and evidence. Please email Ginny Weir, CEO, at gweir@qualityhealth.org with any questions.

The OIC wants to recognize and thank OneHealthPort for its partnership and the many accomplishments achieved through its administrative simplification work. It established principles and values that will be sustained into the future as the Foundation for Healthcare Quality steps into its new role.

Any questions can be submitted to policy@oic.wa.gov

Washington — Prior authorization proposed rule posted: We have released the proposed rule language on R 2024-03, the prior authorization modernization rule. In 2023, the Legislature passed Engrossed Second Substitute House Bill 1357 (RCW 48.43.830) to prevent delays in care and improve health outcomes. To implement the new law, several Washington Administrative Code (WAC) provisions within Chapter 284-43 Subchapter D need amendments. This proposed rule updates prior authorization time frames for health care services and prescription drugs and clarifies health plan applicability standards. It ensures that all affected health care entities and carriers understand their rights and obligations under the new law.

We scheduled a public hearing on the rule:

When: Wednesday, December 11, 2024, at 10:00 a.m 

Where: Virtual meeting, please register in advance.

Comments on the proposed rule language are due at 12:00 p.m. on December 12, 2024. Please send them to rulescoordinator@oic.wa.gov.

For more information, including the proposed rule language (CR-102), please visit the Prior authorization modernization (R 2024-03) webpage.