WAC 246-25-115   Contents of requests for informal opinions and written petitions.  The following information shall accompany any written petition or request for informal opinion submitted to the commission:

     (1) Identification of parties. Identify all parties to the proposal, and their parent entities, and for each one state:

     (a) The name(s) under which it is doing business, or proposes to do business, in Washington;

     (b) Its business address(es);

     (c) Its type of business organization (for example, corporation, sole proprietorship, partnership, or association);

     (d) A brief description of the nature or type of business conducted at each of its business locations within the state of Washington; and

     (e) The person to whom questions regarding the request or petition should be directed.

     (2) Nature and description of proposal. State or describe:

     (a) The nature and type of transaction (for example, joint venture, acquisition, or merger)

     (b) The business(es) involved or affected;

     (c) The products and services involved or affected;

     (d) The scheduled timeline, including expected dates of any major events required to consummate the proposed activity;

     (e) The geographic area(s) in which business will be conducted;

     (f) Whether the same products or services as those listed in (c), above, are currently offered within thirty miles of the geographic area(s) identified in (e), above, and if so, by whom; and

     (g) The extent to which the participants share substantial risk including, but not limited to: (1) The extent to which the venture agrees to provide services on a capitated basis, or (2) the extent to which the venture creates significant financial incentives for its participants as a group to achieve specified cost containment goals, such as withholding a substantial amount of compensation due to participants, with distribution of that amount to participants only if the cost containment goals are met.

     (h) A general description of any anticipated impact of the proposal on competition, including but not limited to the description of the business(es) involved or affected, the effect upon the parties in their competition with each other, the changes in market share among certified plans, health care providers or health care facilities in the geographic product or service area, the presence and entry of new market participants sufficient to deter or counteract the anti-competitive effects of the proposed activity, and availability of arrangements less restrictive to competition that would achieve the same or similar benefits to the community in health care delivery.

     (i) The exclusive or nonexclusive nature of the proposal including, but not limited to (1) the extent to which viable competing networks or plans with adequate provider participation currently exist in the market, (2) the extent to which providers in the proposed network actually participate in other networks or contract individually with health benefit plans, or other evidence of their willingness and incentives to do so, (3) the extent to which providers in the proposed network will earn substantial revenue outside the network, (4) the absence of any indication of significant departicipation from other networks in the market as a result of the proposed venture, and (5) the absence of any indications of coordination among the providers in the network regarding price or other competitively significant terms of participation in other networks or plans.

     (3) Simultaneous review. Identify any other state or federal agency reviewing the proposal and state the date on which each review was requested.

     (4) Identify the name and address of all employee organizations representing the applicant's employees.

     (5) Description of how conduct will meet the goals of health care reform. Describe in narrative form how the proposal will:

     (a) Enhance the quality, access and cost of health services to consumers;

     (b) Gain cost efficiency in the provision of health services;

     (c) Improve utilization of health services, facilities and equipment;

     (d) Avoid duplication of health services resources;

     (e) Facilitate the exchange of information relating to performance expectations;

     (f) Develop comprehensive, integrated, and cost-effective health services delivery in the geographic, product or service area;

     (g) Reduce competition among certified health plans, health care providers, or health care facilities;

     (h) Have an impact on the quality, availability, or price of health services to consumers;

     (i) Reduce the number of people employed or otherwise impact how employees deliver health care services; and

     (j) Change or otherwise have an impact on employee to patient ratios and how this will affect the quality of health services available to consumers.



[Statutory Authority: RCW 43.72.310. 99-04-049, recodified as § 246-25-115, filed 1/28/99, effective 1/28/99; 95-04-112, § 245-02-115, filed 2/1/95, effective 3/4/95.]