1046‑S AMH PATT HAGE 12

 

SHB 1046 ‑ H AMD FAILED 2/10/95 059

By Representative Patterson

     On page 7, line 1, strike "RCW 43.72.080 and 1993 c 492 s 425;"

 

 

 

 

 

EFFECT:  Deletes Health insurance purchasing cooperatives--Designation of regions by commission--Information systems--Minimum standards and rules repealer.  If adopted, the effect would be to maintain in law all of the Washington Health Services Act, except for Health insurance purchasing cooperatives‑-Designation of regions by commission‑-Information systems‑-Minimum standards and rules.

 

 

 

      RCW 43.72.080  Health insurance purchasing cooperatives‑-Designation of regions by commission‑-Information systems‑-Minimum standards and rules.  (1) The commission shall designate four geographic regions within the state in which health insurance purchasing cooperatives may operate, based upon population, assuming that each cooperative must serve no less than one hundred fifty thousand persons; geographic factors; market conditions; and other factors deemed appropriate by the commission.  The commission shall designate one health insurance purchasing cooperative per region.

      (2) In coordination with the commission and consis­tent with the provisions of chapter 70.170 RCW, the department of health shall establish an information clearinghouse for the collection and dissemination of information necessary for the efficient operation of cooperatives, including the establishment of a risk profile information system related to certified health plan enrollees that would permit the equitable distribu­tion of losses among plans in accordance with RCW 43.72.040(7).

      (3) Every health insurance purchasing cooperative shall:

      (a) Admit all individuals, employers, or other groups wishing to participate in the cooperative;

      (b) Make available for purchase by cooperative members every health care program offered by every certified health plan operating within the cooperative's region;

      (c) Be operated as a member-governed and owned, nonprofit cooperative in which no certified health plan, health maintenance organization, health care service contractor, independent practice association, indepen­dent physician organization, or any individual with a pecuniary interest in any such organization, shall have any pecuniary interest in or management control of the cooperative;

      (d) Provide for centralized enrollment and premium collection and distribution among certified health plans; and

      (e) Serve as an ombudsman for its members to resolve inquiries, complaints, or other concerns with certified health plans.

      (4) Every health insurance purchasing cooperative shall assist members in selecting certified health plans and for this purpose may devise a rating system or similar system to judge the quality and cost-effective­ness of certified health plans consistent with guide­lines established by the commission.  For this purpose, each cooperative and directors, officers, and other employees of the cooperative are immune from liability in any civil action or suit arising from the publication of any report, brochure, or guide, or dissemination of information related to the services, quality, price, or cost-effectiveness of certified plans unless actual malice, fraud, or bad faith is shown.  Such immunity is in addition to any common law or statutory privilege or immunity enjoyed by such person, and nothing in this section is intended to abrogate or modify in any way such common law or statutory privilege or immunity.

      (5) Every health insurance purchasing cooperative shall bear the full cost of its operations, including the costs of participating in the information clearing­house, through assessments upon its members.  Such assessments shall be billed and accounted for separately from premiums collected and distributed for the purchase of the uniform benefits package or any other supplemen­tal insurance or health services program.

      (6) No health insurance purchasing cooperative may bear any financial risk for the delivery of uniform benefits package services, or for any other supple­mental insurance or health services program.

      (7) No health insurance purchasing cooperative may directly broker, sell, contract for, or provide any insurance or health services program.  However, nothing contained in this section shall be deemed to prohibit the use or employment of insurance agents or brokers by the cooperative for other purposes or to prohibit the facilitation of the sale and purchase by members of supplemen­tal insurance or health services programs.

      (8) The commission may adopt rules necessary for the implementation of this section including rules governing charter and bylaw provisions of coopera­tives and may adopt rules prohibiting or permitting other activities by coopera­tives.

      (9) The commission shall consider ways in which cooperatives can develop, encourage, and provide incentives for employee wellness programs.  [1993 c 492 ' 425.]

 

NOTES:

 

Certification:  Chapter 48.43 RCW.