Section 182-22-450. MHCS duties.

(1) When an MHCS assists applicants in the enrollment process, it must provide them with the toll-free number for BHP or WHP and information on all MHCS available within the applicant's county of residence and the estimated premiums for each available MHCS.

(2) An MHCS shall pay a nonparticipating provider no more than the lowest amount paid for that service under the MHCS's contracts with similar providers in the state.

(a) For services provided to plan enrollees on or after the effective date of this section, nonparticipating providers must accept as payment in full the amount paid by the managed health care system under RCW 70.47.100(2) in addition to any deductible, coinsurance, or copayment that is due from the enrollee under the terms and conditions set forth in the MHCS contract with the administrator.

(b) A plan enrollee is not liable to any nonparticipating provider for covered services, except for amounts due for any deductible, coinsurance, or copayment under the terms and conditions set forth in the managed health care system contract with the administrator.

(3) Pursuant to federal managed care access standards, 42 C.F.R. Sec. 438, MHCS's must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the authority, including hospital-based physician services.

[Statutory Authority: Chapter 70.47 RCW. WSR 11-15-020, § 182-22-450, filed 7/8/11, effective 8/8/11; WSR 10-24-062 (Order 10-03), § 182-22-450, filed 11/30/10, effective 12/31/10.]

Chapter 70.47 RCW. WSR 11-15-020, § 182-22-450, filed 7/8/11, effective 8/8/11; WSR 10-24-062 (Order 10-03), § 182-22-450, filed 11/30/10, effective 12/31/10.