H-3181

AN ACT Relating to medical care; amending RCW 74.09.700 and 74.09.730; adding a new chapter to Title 82 RCW; creating new sections; making appropriations; providing effective dates; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. DEFINITIONS. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "State medicaid receipts" means that portion of the gross income of the business that consists of Washington state general fund payments attributable to the medicaid program, other than from federal sources, for inpatient and outpatient hospital services under the medical assistance program provided in RCW 74.09.520 or under the limited casualty program provided in RCW 74.09.700 for persons who are medically needy under the social security Title XIX state plan.

(2) "Hospital" means a hospital required to be licensed under chapter 70.41 RCW, or a private hospital required to be licensed under chapter 71.12 RCW, but not including federal hospitals or state hospitals established under chapter 72.23 RCW.

(3) The meaning given to words and phrases in chapter 82.04 RCW apply throughout this chapter, to the extent applicable.

NEW SECTION. Sec. 2. In addition to any other tax, a tax is imposed on every hospital for the act or privilege of engaging in business within this state. The tax is equal to state medicaid receipts multiplied by the rate of twenty percent.

NEW SECTION. Sec. 3. Chapter 82.32 RCW applies to the tax imposed in this chapter. The tax due dates, reporting periods, and return requirements applicable to chapter 82.04 RCW apply equally to the tax imposed in this chapter.

NEW SECTION. Sec. 4. This chapter is temporary and shall expire on the earliest of:

(1) The date that federal medicaid matching funds for the purposes specified in section 10(1) of this act become unavailable or are substantially reduced, as such date is certified by the secretary of social and health services;

(2) The date that federal medicaid matching funds for the purposes specified in section 10(1) of this act become unavailable or are substantially reduced, as determined by a permanent injunction, court order, or final court decision; or

(3) July 1, 1993.

NEW SECTION. Sec. 5. (1) The expiration of sections 1 through 4 of this act shall not be construed as affecting any existing right acquired or liability or obligation incurred under those sections or under any rule or order adopted under those sections, nor as affecting any proceeding instituted under those sections.

(2) Taxes that have been paid under sections 1 through 4 of this act, but are properly attributable to taxable events occurring after the expiration of those sections, shall be credited or refunded as provided in RCW 82.32.060.

NEW SECTION. Sec. 6. Sections 1 through 4 of this act shall constitute a new chapter in Title 82 RCW.

Sec. 7. RCW 74.09.700 and 1991 c 233 s 2 are each amended to read as follows:

(1) To the extent of available funds and subject to any conditions placed on appropriations made for this purpose, medical care may be provided under the limited casualty program to persons not otherwise eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX state plan and medical indigents in accordance with ((~~medical~~)) eligibility requirements established by the department. The eligibility requirements may include minimum levels of incurred medical expenses. This includes residents of skilled nursing homes, intermediate care facilities, and intermediate care facilities for the mentally retarded who are aged, blind, or disabled as defined in Title XVI of the federal social security act and whose income exceeds three hundred percent of the federal supplement security income benefit level.

(2) Determination of the amount, scope, and duration of medical coverage under the limited casualty program shall be the responsibility of the department, subject to the following:

(a) Only ((~~inpatient hospital services; outpatient hospital and~~)) the following services may be covered:

(i) For persons who are medically needy as defined in the social security Title XIX state plan: Inpatient and outpatient hospital services;

(ii) For persons who are medically needy as defined in the social security Title XIX state plan, and for persons who are medical indigents under the eligibility requirements established by the department: Rural health clinic services; physicians' and clinic services; prescribed drugs, dentures, prosthetic devices, and eyeglasses; skilled nursing home services, intermediate care facility services, and intermediate care facility services for the mentally retarded; home health services; other laboratory and x‑ray services; rehabilitative services, including occupational therapy; medically necessary transportation; and other services for which funds are specifically provided in the omnibus appropriations act ((~~shall be covered~~));

(b) ((Persons who are medically indigent and are not eligible for a federal aid program shall satisfy a deductible of not less than one hundred dollars nor more than five hundred dollars in any twelve-month period;

~~(c)~~)) Medical care services provided to the medically indigent and received no more than seven days prior to the date of application shall be retroactively certified and approved for payment on behalf of a person who was otherwise eligible at the time the medical services were furnished: PROVIDED, That eligible persons who fail to apply within the seven‑day time period for medical reasons or other good cause may be retroactively certified and approved for payment.

(3) The department shall establish standards of assistance and resource and income exemptions. All nonexempt income and resources of limited casualty program recipients shall be applied against the cost of their medical care services.

Sec. 8. RCW 74.09.730 and 1989 c 260 s 1 are each amended to read as follows:

In establishing Title XIX payments ((~~rates~~)) for inpatient hospital services:

(1) The department of social and health services shall ((~~take into account the situation of hospitals which serve a disproportionate number of low-income patients with special needs;~~

~~(2) The department shall define eligible disproportionate share hospitals by regulation, and shall consider~~)) provide a disproportionate share hospital adjustment considering the following components:

(a) A low‑income care component based on a hospital's medicaid utilization rate, its low-income utilization rate, ((~~and~~)) its provision of obstetric services, and other factors authorized by federal law;

(b) A medical indigency care component based on a hospital's services to persons who are medically indigent; and

(c) A state‑only component, to be paid from available state funds to hospitals that do not qualify for federal payments under (b) of this subsection, based on a hospital's services to persons who are medically indigent;

((~~(3)~~)) (2) The payment methodology for disproportionate share hospitals shall be specified by the department in regulation.

NEW SECTION. Sec. 9. (1) In addition to the components in RCW 74.09.730, the department of social and health services shall consider the following components in providing disproportionate share hospital adjustments:

(a) A medicaid care component proportionately based on a hospital's services to persons who are eligible for medicaid; and

(b) A state‑only component, to be paid from available state funds to hospitals that do not qualify for federal payments under (a) of this subsection, based on a hospital's services to persons who are eligible for medicaid.

(2) Each in-state hospital that provides care to medicaid beneficiaries shall be eligible for payments under either subsection (1) (a) or (b) of this section.

(3) This section shall expire on the expiration date of sections 1 through 4 of this act.

NEW SECTION. Sec. 10. (1) The sum of one hundred twenty-eight million four hundred ten thousand dollars from the state general fund, of which sixty-nine million nine hundred thousand dollars is from the general fund‑-federal, is hereby appropriated for the fiscal period beginning September 1, 1991, and ending June 30, 1993, to the medical assistance program of the department of social and health services for the purpose of the payment of the components of the disproportionate share adjustment under section 9 of this act. The appropriation in this subsection shall lapse on the date that sections 1 through 4 of this act expire. Amounts that have been paid under this subsection, but are properly attributable to a period after the expiration of sections 1 through 4 of this act, shall be repaid or credited to the state as provided in rules of the department.

(2) The sum of thirty-eight million one hundred eighty-seven thousand dollars from the state general fund, of which twenty million nine hundred ninety-five thousand dollars is from the general fund‑-federal, is hereby appropriated for the biennium ending June 30, 1993, to the medical assistance program of the department of social and health services for the purpose of the payment of the medical indigency care components of the disproportionate share adjustment under RCW 74.09.730(1) (b) and (c).

(3) The allotments from the appropriations in this section shall be made so as to enable expenditure of the appropriations through the end of the 1991‑93 biennium.

(4) The appropriations is this section are supplemental to other appropriations to the medical assistance program. The department of social and health services shall not use the moneys appropriated in this section in lieu of any other appropriations for the medical assistance program.

NEW SECTION. Sec. 11. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect on July 1, 1991, except sections 1 through 6 and 9 of this act which shall take effect on September 1, 1991.