The Washington Office of the Insurance Commissioner (OIC) recently finalized new rules and concise explanatory statement regarding registration and reporting by Health Care Benefit Managers (HCBMs), effective December 21, 2023. The new rules include improvements to reporting and oversight of HCBMs.
A health care benefit manager is defined as a person or entity providing services to, or acting on behalf of, a health carrier or employee benefits programs, that directly or indirectly impacts the determination or utilization of benefits for, or patient access to, health care services, drugs, and supplies. This includes pharmacy benefit managers as well as benefit managers used by carriers for other services such as radiology. The new rules streamline the current HCBM registration and reporting process to reduce administrative burden. It also adds important new reporting requirements for HCBMs:
- The identity of any entity for which the health care benefit manager has a controlling interest.
- If the health care benefit manager has committed any violations in this or any state or been the subject of an order from a department of insurance or other state agency of any federal or state agency or court.
(Andrew Busz, andrewb@wsha.org)
