Washington Balance Billing Attestation Changes

The Washington state Balance Billing Protection Act (BPPA) became effective January 1, 2020. The law protects members from surprise or balance billing for emergency care or out-of-network care at in-network facilities. The WA BBPA applies only to our members residing in Washington state and covered under fully insured plans or participating self-funded plans.

In 2024, the legislature passed SB 5986, which adds ground ambulance services to the WA BBPA. Under the new law, out-of-network Ground Ambulance Service Organization (GASO) must bill the health plan. The law limits the member’s cost-sharing amount to what it would be if the GASO was in-network. Any cost-sharing paid by the member also counts towards their deductible, if applicable. The GASO can’t balance bill the member or ask them to waive their balance billing protections.

Through December 31, 2027, the proposed rulemaking sets the rate payment formula for out-of-network transport at:

• The locally set rate as established by the local governmental entity, or if this does not exist,
• The lesser of billed charges, or 325% of current Medicare rate

The new law takes effect beginning January 1, 2025.

Self-funded and OptiFlex clients

On October 22, Premera Blue Cross received a notification from the Washington Office of the Insurance Commissioner that participating self-funded and OptiFlex groups must opt in again to continue balance billing protections in 2025. Previously, participation for self-funded and OptiFlex groups was considered “evergreen” and didn’t require the group to opt in at each renewal.

What you need to know

• All self-funded and OptiFlex groups must opt in again with their 2025 renewal.
• To opt in again, a group can:
  • Return a new attestation form indicating their decision to opt back into the protection
  • Return their Decision Point document with “Renew As-Is” or “Opt in” selected
  • Affirm their decision to continue opting in via email from the group

• The group’s decision must be provided to Premera no later than December 16, 2024 to allow time for submission to the OIC.

Next steps

Work with your Premera account representative to:

• Contact all self-funded and OptiFlex groups.
• Obtain confirmation (using one of the options above) from each group affirming their decision to opt in.
• Ensure the group’s decision is submitted to Premera by December 16, 2024.

For any inquiries or further clarification regarding the legislative changes to the Balance Billing Protection Act, contact your Premera account representative.