H-0021.1 _______________________________________________
HOUSE BILL 1296
_______________________________________________
State of Washington 53rd Legislature 1993 Regular Session
By Representatives Morris, Peery, Ogden, Dellwo, H. Myers, Carlson and Springer
Read first time 01/22/93. Referred to Committee on Health Care.
AN ACT Relating to charity care requirements for health maintenance organizations; and adding new sections to chapter 48.46 RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. A new section is added to chapter 48.46 RCW to read as follows:
The legislature finds that the lack of access to health care is a growing problem. This is even more troublesome in areas of the state where there is a shortage of health providers. RCW 48.46.030 requires health maintenance organizations providing services within Washington state to offer comprehensive health care services. Health maintenance organizations may satisfy this requirement by providing comprehensive health care services in organization-owned and operated facilities or by arrangement with other health care entities. The legislature finds that most health maintenance organizations operating in Washington state satisfy the comprehensive health care requirement and contribute by providing charity care for indigent Washington residents in one of two ways: Either by operating a hospital located in Washington state which is subject to the mandatory charity care requirements of RCW 70.170.060; or by contracting with hospitals located in Washington state and subsidizing the charity care these hospitals are required to provide.
The legislature also finds that health maintenance organizations doing business in both Washington and adjoining states can avoid their fair share of the cost of providing charity care under RCW 70.170.060 by providing hospital services in neighboring states. This practice causes unfair competition by imposing a disproportionate share of the burden of providing unsubsidized charity care on in-state health care entities.
NEW SECTION. Sec. 2. A new section is added to chapter 48.46 RCW to read as follows:
(1) Every health maintenance organization, as defined in this section, shall provide an annual measure of charity care where the organization does business that is equal to the amount established through the following formula:
(a) The organization's annual per capita rate of charge within the county multiplied by;
(b) The percentage of the health services business conducted by that organization within the county, multiplied by;
(c) The number of low-income persons who reside within the county.
(2) Every health maintenance organization, as defined in this section, has satisfied the charity care requirement of subsection (1) of this section if it contracts with or maintains any hospital or hospitals subject to the requirements of RCW 70.170.060, located within the county in Washington state in which the organization does business, to provide hospital services to all of the organization's participants who are residents of Washington state residing within that county.
(3) The annual per capita rate of charges, as required in subsection (1)(a) of this section, shall be submitted by the organization to the insurance commissioner annually. The percentage of business conducted as required in subsection (1)(b) of this section shall be determined by the insurance commissioner. The number of uninsured persons for each county, as required by subsection (1)(c) of this section, shall be determined by the administrator of the Washington basic health plan.
(4) As used in this section:
(a) "Charity care" means necessary health care rendered to uninsured persons to the extent that the person is unable to pay for the health care as determined by the insurance commissioner based on the rules established by the department of health in determining charity care requirements for hospitals.
(b) "Health maintenance organization" means a health maintenance organization licensed under this chapter to do business in the state of Washington.
(c) "Low-income person" means any person under the age of sixty-five and not otherwise eligible for medicare, who resides in a county where a health maintenance organization does business, and whose gross family income is at or below two hundred percent of the poverty guidelines as adjusted for family size and determined annually by the federal department of health and human services.
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