Washington § 48.39.005 Definitions.

Washington Statutes

§ 48.39.005 — Definitions.

Washington § 48.39.005

Title 48INSURANCE

Ch. 48.39CONTRACTS BETWEEN INSURANCE CARRIERS, HEALTH CARE PROVIDERS, AND THIRD-PARTY PAYORS

This text of Washington § 48.39.005 (Definitions.) is published on Counsel Stack Legal Research, covering Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Wash. Rev. Code § 48.39.005 (2026).

Text

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1)"Health care provider" or "provider" has the same meaning as in RCW 48.43.005 and, for the purposes of this chapter, includes facilities licensed under chapter 70.41 RCW.

(2)"Material amendment" means an amendment to a contract between a payor and health care provider that would result in requiring a health care provider to participate in a health plan, product, or line of business with a lower fee schedule in order to continue to participate in a health plan, product, or line of business with a higher fee schedule. A material amendment does not include any of the following:

(a)A decrease in payment or compensation resulting from a change in a fee schedule published by the

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The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

(1) "Health care provider" or "provider" has the same meaning as in RCW 48.43.005 and, for the purposes of this chapter, includes facilities licensed under chapter 70.41 RCW.

(2) "Material amendment" means an amendment to a contract between a payor and health care provider that would result in requiring a health care provider to participate in a health plan, product, or line of business with a lower fee schedule in order to continue to participate in a health plan, product, or line of business with a higher fee schedule. A material amendment does not include any of the following:

(a) A decrease in payment or compensation resulting from a change in a fee schedule published by the payor upon which the payment or compensation is based and the date of applicability is clearly identified in the contract, compensation addendum, or fee schedule notice;

(b) A decrease in payment or compensation that was anticipated under the terms of the contract, if the amount and date of applicability of the decrease is clearly identified in the contract; or

(c) Changes unrelated to compensation so long as reasonable notice of not less than sixty days is provided.

(3) "Payor" or "third-party payor" means carriers licensed under chapters 48.20 , 48.21, 48.44, and 48.46 RCW, and *managed health care systems as defined in RCW 74.09.522 .

Reviser's note: *(1) RCW 74.09.522 was amended by 2023 c 51 s 43, removing the definition of "managed health care system" and changing "managed health care system" to "managed care organization."

(2) The definitions in this section have been alphabetized pursuant to RCW 1.08.015 (2)(k).