Washington State Flexibility to Stabilize the Market Grant Award

Grant Application Summary

Washington Grantee: Washington State Office of Insurance Commissioner

Award Date: August 20, 2018

Total Award: $284,135.00

Baseline Award: $274,344.83

Workload Award: $9,790.17

Section 2702 -The Washington State Office of Insurance Commissioner will fund one project with two phases. During the first phase, in addition to ensuring health insurance issuers are offering approved products for purchase, Washington will conduct two successive market scans focused on identifying issues related to insufficient coverage in the market and issues that undermine affordability. The Washington State Office of Insurance Commissioner will also hire a contractor to analyze issuers’ medical necessity and prior authorization criteria and procedures related to behavioral health services. During the second phase, Washington will conduct a data call for denied and out-of-network claims, merge the data with the Washington State All Payer Claims Database (APCD), and analyze the combined dataset. The Washington State Office of Insurance Commissioner will compile findings from both phases into a report detailing the issues detected and recommendations for solutions.