AN ACT Relating to
long-term care benefits for public employees; and amending RCW 41.05.065.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
Sec. 1. RCW 41.05.065 and 1995
1st sp.s. c 6 s 5 are each amended to read as follows:
(1) The board shall
study all matters connected with the provision of health care coverage, life
insurance, liability insurance, accidental death and dismemberment insurance,
and disability income insurance or any of, or a combination of, the enumerated
types of insurance for employees and their dependents on the best basis
possible with relation both to the welfare of the employees and to the state.
However, liability insurance shall not be made available to dependents.
(2) The board shall
develop employee benefit plans that include comprehensive health care benefits
for all employees. In developing these plans, the board shall consider the
following elements:
(a) Methods of
maximizing cost containment while ensuring access to quality health care;
(b) Development of
provider arrangements that encourage cost containment and ensure access to
quality care, including but not limited to prepaid delivery systems and
prospective payment methods;
(c) Wellness incentives
that focus on proven strategies, such as smoking cessation, injury and accident
prevention, reduction of alcohol misuse, appropriate weight reduction,
exercise, automobile and motorcycle safety, blood cholesterol reduction, and
nutrition education;
(d) Utilization review
procedures including, but not limited to a cost-efficient method for prior
authorization of services, hospital inpatient length of stay review,
requirements for use of outpatient surgeries and second opinions for surgeries,
review of invoices or claims submitted by service providers, and performance
audit of providers;
(e) Effective
coordination of benefits;
(f) Minimum standards
for insuring entities; and
(g) Minimum scope and
content of public employee benefit plans to be offered to enrollees
participating in the employee health benefit plans. To maintain the
comprehensive nature of employee health care benefits, employee eligibility
criteria related to the number of hours worked and the benefits provided to
employees shall be substantially equivalent to the state employees' health
benefits plan and eligibility criteria in effect on January 1, 1993. Nothing
in this subsection (2)(g) shall prohibit changes or increases in employee
point-of-service payments or employee premium payments for benefits.
(3) The board shall
design benefits and determine the terms and conditions of employee
participation and coverage, including establishment of eligibility criteria.
(4) The board may
authorize premium contributions for an employee and the employee's dependents
in a manner that encourages the use of cost-efficient managed health care
systems.
(5) Employees shall
choose participation in one of the health care benefit plans developed by the
board and may be permitted to waive coverage under terms and conditions
established by the board.
(6) The board shall
review plans proposed by insuring entities that desire to offer property
insurance and/or accident and casualty insurance to state employees through
payroll deduction. The board may approve any such plan for payroll deduction
by insuring entities holding a valid certificate of authority in the state of
Washington and which the board determines to be in the best interests of
employees and the state. The board shall promulgate rules setting forth
criteria by which it shall evaluate the plans.
(7) Before January
1, 1998, the public employees' benefits board shall make available one or more
fully insured long-term care insurance plans that comply with the requirements
of chapter 48.84 RCW. Such programs shall be made available to eligible
employees, retired employees, and retired school employees as well as eligible
dependents which, for the purpose of this section, includes the parents of the
employee or retiree and the parents of the spouse of the employee or retiree.
Employees of local governments and employees of political subdivisions not
otherwise enrolled in the public employees' benefits board sponsored medical
programs may enroll under terms and conditions established by the
administrator, if it does not jeopardize the financial viability of the public
employees' benefits board's long-term care offering.
(a) Participation of
eligible employees or retired employees and retired school employees in any
long-term care insurance plan made available by the public employees' benefits
board is voluntary and shall not be subject to binding arbitration under
chapter 41.56 RCW. Participation is subject to reasonable underwriting
guidelines and eligibility rules established by the public employees' benefits
board and the health care authority.
(b) The employee,
retired employee, and retired school employee are solely responsible for the
payment of the premium rates developed by the health care authority. The
health care authority is authorized to charge a reasonable administrative fee
in addition to the premium charged by the long-term care insurer, which shall
include the health care authority's cost of administration, marketing, and
consumer education materials prepared by the health care authority and the
office of the insurance commissioner.
(c) To the extent
administratively possible, the state shall establish an automatic payroll or
pension deduction system for the payment of the long-term care insurance
premiums.
(d) The public
employees' benefits board and the health care authority shall establish a
technical advisory committee to provide advice in the development of the
benefit design and establishment of underwriting guidelines and eligibility
rules. The committee shall also advise the board and authority on effective
and cost-effective ways to market and distribute the long-term care product.
The technical advisory committee shall be comprised, at a minimum, of
representatives of the office of the insurance commissioner, providers of
long-term care services, licensed insurance agents with expertise in long-term
care insurance, employees, retired employees, retired school employees, and
other interested parties determined to be appropriate by the board.
(e) The health care
authority shall offer employees, retired employees, and retired school
employees the option of purchasing long-term care insurance through licensed
agents or brokers appointed by the long-term care insurer. The authority, in
consultation with the public employees' benefits board, shall establish
marketing procedures and may consider all premium components as a part of the
contract negotiations with the long-term care insurer.
(f) In developing
the long-term care insurance benefit designs, the public employees' benefits
board shall include an alternative plan of care benefit, including adult day
services, as approved by the office of the insurance commissioner.
(g) The health care
authority, with the cooperation of the office of the insurance commissioner,
shall develop a consumer education program for the eligible employees, retired
employees, and retired school employees designed to provide education on the
potential need for long-term care, methods of financing long-term care, and the
availability of long-term care insurance products including the products
offered by the board.
(h) By
December 1998, the health care authority, in consultation with the public
employees' benefits board, shall submit a report to the appropriate committees
of the legislature, including an analysis of the marketing and distribution of
the long-term care insurance provided under this section.
