Washington Code 70.47.080 – Enrollment of applicants — Participation limitations
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On and after July 1, 1988, the *administrator shall accept for enrollment applicants eligible to receive covered basic health care services from the respective managed health care systems which are then participating in the plan.
Terms Used In Washington Code 70.47.080
- Managed health care system: means : (a) Any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, or any combination thereof, that provides directly or by contract basic health care services, as defined by the director and rendered by duly licensed providers, to a defined patient population enrolled in the plan and in the managed health care system; or (b) a self-funded or self-insured method of providing insurance coverage to subsidized enrollees provided under RCW 41. See Washington Code 70.47.020
- plan: means the system of enrollment and payment for basic health care services, administered by the plan director through participating managed health care systems, created by this chapter. See Washington Code 70.47.020
Thereafter, total subsidized enrollment shall not result in expenditures that exceed the total amount that has been made available by the legislature in any act appropriating funds to the plan. To the extent that new funding is appropriated for expansion, the *administrator shall endeavor to secure participation contracts from managed health care systems in geographic areas of the state that are unserved by the plan at the time at which the new funding is appropriated. In the selection of any such areas the *administrator shall take into account the levels and rates of unemployment in different areas of the state, the need to provide basic health care coverage to a population reasonably representative of the portion of the state’s population that lacks such coverage, and the need for geographic, demographic, and economic diversity.
The *administrator shall at all times closely monitor growth patterns of enrollment so as not to exceed that consistent with the orderly development of the plan as a whole, in any area of the state or in any participating managed health care system. The annual or biennial enrollment limitations derived from operation of the plan under this section do not apply to nonsubsidized enrollees as defined in **RCW 70.47.020(5).
NOTES:
Reviser’s note: *(1) The definition of “administrator” was changed to “director” in RCW 70.47.020 by 2011 1st sp.s. c 15 § 83.
**(2) RCW 70.47.020 was amended by 2011 1st sp.s. c 9 § 3, changing subsection (5) to subsection (6).
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.