Lori Grassi WSCA Executive of Legislation and Policy


From Legislation to Collaboration: The Next Step in Provider Contracting Reform


For more than two years, the Washington State Chiropractic Association has been leading a broad coalition of health care professions in an effort to address one of the most significant challenges facing independent health care practices: stagnant reimbursement rates and the lack of meaningful negotiation between health carriers and community-based providers.


That work began with House Bill 1655, legislation introduced during the 2023-24 legislative biennium that would have required health carriers to provide annual fee schedule increases tied to the Consumer Price Index (CPI) for independent providers. The bill was supported by a diverse coalition of health care professions who shared a common concern: many providers had gone years, and in some cases decades, without meaningful reimbursement increases despite rising practice expenses, inflation, workforce costs, and regulatory requirements. The legislation highlighted the growing disparity between the cost of providing care and the reimbursement received by independent practices.


While HB 1655 generated significant discussion and gained support from lawmakers and provider organizations, it also revealed the complexity of the issues surrounding provider reimbursement and carrier contracting practices.


legislative efforts demonstrated that providers across numerous disciplines share common concerns regarding reimbursement adequacy, contract transparency, administrative burdens, and patient access to care. They also underscored the reality that lasting solutions will require input from a wide range of stakeholders, including providers, health carriers, consumers, and policymakers.


Recognizing both the importance and complexity of these issues, the Washington State Legislature included funding in the 2026 supplemental budget for a facilitated stakeholder process through the William D. Ruckelshaus Center. Rather than continuing the discussion solely through the legislative process, lawmakers chose to create a structured forum where affected parties can engage in collaborative problem solving and explore potential solutions outside the traditional legislative environment. The Ruckelshaus Center has a long history of bringing together diverse interests to address challenging public policy issues and develop recommendations that can inform future legislative and regulatory actions. (Ruckelshaus Center): https://ruckelshauscenter.wsu.edu/ current-projects/.


The


conversation continued during the 2025 legislative session with House Bill 1589, sponsored by Representative Dan Bronoske. HB 1589 focused more broadly on the relationship between health carriers and contracting providers, addressing concerns about transparency, contract negotiations, fee schedules, and the ability of providers to participate in meaningful discussions regarding the terms under which they deliver care. The bill passed the House of Representatives with strong bipartisan support before ultimately stalling in the Senate. (Washington State Legislature: https://app.leg.wa.gov/billsumm ary?BillNumber=1589&Initiative=false&Year=2025)


Together, HB 1655 and HB 1589 elevated an issue that affects not only chiropractors but also many other independent health care professionals throughout Washington State. These


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The study will examine concerns related to provider reimbursement, contracting practices, and the relationship between health carriers and health care providers. Participants will have the opportunity to identify barriers, evaluate existing practices, and explore potential policy solutions that promote both patient access and sustainable provider networks. The goal is not simply to revisit previous legislative proposals but to develop a shared understanding of the challenges and identify areas where meaningful progress can be achieved.


The WSCA strongly supported this approach because it ensures that providers will have a seat at the table and that the experiences of community-based practitioners will be heard directly by decision makers and other stakeholders. While legislation can sometimes force difficult issues into a compressed timeline, the Ruckelshaus process


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