BP BHEAD INT S

AN ACT Relating to consumer protection in the purchase of health care; amending RCW 48.30.010; adding new sections to chapter 43.72 RCW; adding a new section to chapter 48.01 RCW; adding a new section to chapter 43.70 RCW; adding new sections to chapter 48.43 RCW; adding a new section to chapter 70.47 RCW; adding a new section to chapter 43.19 RCW; adding a new section to Title 51 RCW; adding a new chapter to Title 48 RCW; creating new sections; repealing RCW 48.43.020, 48.43.030, 48.43.040, 48.43.050, 48.43.060, 48.43.070, 48.43.080, 48.43.090, 48.43.100, 48.43.110, 48.43.120, 48.43.130, 48.43.150, 43.72.220, 43.72.240, 43.72.810, 43.72.210, and 43.72.120; making appropriations; providing an effective date; and declaring an emergency.

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

PART I

PROTECTION OF CONSUMER CHOICE AND QUALITY HEALTH CARE

NEW SECTION. Sec. 1. The legislature intends through the enactment of Part I of this act to protect an individual's right to decide from which provider he or she will receive health services and to maintain a high quality health care system. The legislature intends to achieve this by: Requiring certain insurers to offer a plan that allows consumers to see "any willing provider"; maintaining traditional indemnity insurance plans in addition to managed care plans; allowing the use of medical savings accounts; providing whistleblower protection for anyone who complains about the quality of care in any health facility or within any health plan; requiring full disclosure of the contents of a health plan; requiring disclosure of staff ratios in hospitals and qualifications of providers; requiring plans to conduct annual patient satisfaction surveys; and allowing employers, individuals, health care facilities, and religiously sponsored health plans to choose nonparticipation with any health service to which they object.

NEW SECTION. Sec. 2. A new section is added to chapter 43.72 RCW to read as follows:

In addition to the requirements under RCW 43.72.100, a certified health plan, except for a health maintenance organization licensed under chapter 48.46 RCW, shall offer the minimum list of health services to all Washington residents in at least one plan that provides direct enrollee access to any health provider eligible to receive payment under that plan. This plan shall encourage, but not require, its enrollees to use the most cost-effective providers. Differential reimbursement to providers shall be permitted in this plan. Within this plan, the certified health plan must permit every health care provider willing and able to meet the terms and conditions of the plan to provide health services or care for conditions included in the minimum list of health services to the extent that:

(1) The provision of such health services or care is within the health care providers' permitted scope of practice; and

(2) The providers agree to abide by standards related to:

(a) Provision, utilization review, and cost containment of health services;

(b) Management and administrative procedures; and

NEW SECTION. Sec. 3. A new section is added to chapter 43.72 RCW to read as follows:

In addition to the meaning ascribed to it in RCW 43.72.010, "managed care" means an integrated system of insurance, financing, and health services delivery functions that assumes financial risk for delivery of health services and includes the following cost containment features: Second surgical opinions, precertification authorization, utilization review, and high cost case management.

NEW SECTION. Sec. 4. (1) This chapter shall be known as the medical care savings account act.

(2) The legislature recognizes that the costs of health care are increasing rapidly and most individuals are removed from participating in the purchase of their health care.

As a result, it becomes critical to encourage and support solutions to alleviate the demand for diminishing state resources. In response to these increasing costs in health care spending, the legislature intends to clarify that medical care savings accounts may be offered as health benefit options to all residents as incentives to reduce unnecessary health services utilization, administration, and paperwork, and to encourage individuals to be in charge of and participate directly in their use of service and health care spending. To alleviate the possible impoverishment of residents requiring long-term care, medical care savings accounts may promote savings for long-term care and provide incentives for individuals to protect themselves from financial hardship due to a long-term health care need.

(3) Medical care savings accounts are authorized in Washington state as options to employers and residents.

NEW SECTION. Sec. 5. A new section is added to chapter 48.01 RCW to read as follows:

(1) The identity of a whistleblower who complains, in good faith, to the department of health about the improper quality of care provided by a plan, as defined in RCW 43.72.010, shall remain confidential. The identity of the whistleblower shall remain confidential unless the commission determines that the complaint was not made in good faith. An employee who is a whistleblower, as defined in this section, and who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action has the remedies provided under chapter 49.60 RCW.

(2)(a) "Quality of care" means any practice, procedure, action, or failure to act that is determined by the applicable state health licensing authority under Title 18 RCW to violate accepted standards of practice.

(b) "Reprisal or retaliatory action" means but is not limited to: Denial of adequate staff to perform duties; frequent staff changes; frequent and undesirable office changes; refusal to assign meaningful work; unwarranted and unsubstantiated letters of reprimand or unsatisfactory performance evaluations; demotion; reduction in pay; denial of promotion; suspension; dismissal; denial of employment; and a supervisor or superior encouraging coworkers to behave in a hostile manner toward the whistleblower.

(c) "Whistleblower" means a consumer, employee, or health care professional who in good faith reports alleged quality of care concerns to the health services commission.

(3) Nothing in this section prohibits a plan from making any decision exercising its authority to terminate, suspend, or discipline an employee who engages in workplace reprisal or retaliatory action against a whistleblower.

NEW SECTION. Sec. 6. A new section is added to chapter 43.70 RCW to read as follows:

(1) The identity of a whistleblower who complains, in good faith, to the department of health about the improper quality of care in a health care facility, as defined in RCW 43.72.010, shall remain confidential. The identity of the whistleblower shall remain confidential unless the commission determines that the complaint was not made in good faith. An employee who is a whistleblower, as defined in this section, and who as a result of being a whistleblower has been subjected to workplace reprisal or retaliatory action has the remedies provided under chapter 49.60 RCW.

(c) "Whistleblower" means a consumer, employee, or health care professional who in good faith reports alleged quality of care concerns to the health services commission.

(3) Nothing in this section prohibits a health care facility from making any decision exercising its authority to terminate, suspend, or discipline an employee who engages in workplace reprisal or retaliatory action against a whistleblower.

NEW SECTION. Sec. 7. To ensure that individuals understand their health care options and are able to make informed decisions among them, all certified health plans must provide enrollees and potential enrollees with written disclosure of coverage and benefits, including coverage principles and any exclusions or restrictions on coverage, and make available upon request information on evaluation and treatment policies for specific conditions. Such information must be current, easily understandable, and easily available prior to enrollment and upon request thereafter.

NEW SECTION. Sec. 8. A new section is added to chapter 48.43 RCW to read as follows:

All health care facilities, certified health plans, and providers must disclose the training, qualifications, staff ratios, and backup arrangements of the various health care professionals working at the facility, for the plan, or for the provider. This section does not require a certified health plan, a health care facility, or health provider to adhere to any particular standard that may not be otherwise required by law. However, the department of health shall set in rule procedures and standards by which certified health plans, facilities, and providers must disclose information enumerated in this section. These rules may prescribe the forms and posting requirements for such information.

NEW SECTION. Sec. 9. A new section is added to chapter 48.43 RCW to read as follows:

Certified health plans shall conduct annual patient satisfaction surveys in a form set in rule by the department of health and provide the survey results to their enrollees.

NEW SECTION. Sec. 10. A new section is added to chapter 43.72 RCW to read as follows:

The legislature recognizes that every individual possesses a fundamental right to exercise their religious beliefs and conscience. The legislature further recognizes that in developing public policy, conflicting religious and moral beliefs must be respected. Therefore, while recognizing the right of conscientious objection to participating in specific health services, the state shall also recognize the right of individuals enrolled with a certified health plan to receive the full range of services covered under the minimum list of health services.

NEW SECTION. Sec. 11. A new section is added to chapter 43.72 RCW to read as follows:

(1) No individual health care provider, religiously sponsored certified health plan, or religiously sponsored health care facility may be required by law or contract in any circumstances to directly participate in the provision of or payment for a specific service in this minimum list of health services if they object to so doing for reason of conscience or religion. No person may be discriminated against in employment or professional privileges because of such objection.

(2) The provisions of this section are not intended to result in an enrollee being denied timely access to any service included in the minimum list of health services. Each certified health plan shall:

(a) Provide written notice to enrollees, upon enrollment with the plan and upon enrollee request thereafter, listing, by provider, services that any provider refuses to perform for reason of conscience or religion;

(b) Develop written information describing how an enrollee may directly access, in an expeditious manner, services that the provider refuses to perform; and

(c) Ensure that enrollees refused services under this section have prompt access to the information developed pursuant to (b) of this subsection.

(3) The health care authority shall adopt rules to implement this section and establish a mechanism to ensure enrollees timely access to the minimum list of health services and to assure prompt payment to service providers.

NEW SECTION. Sec. 12. A new section is added to chapter 43.72 RCW to read as follows:

(1) No individual or organization with a religious or moral tenet opposed to a specific service on the minimum list of health services may be required to purchase coverage for that service or services if the individual or organization objects to doing so for reason of conscience or religion.

(2) The provisions of this section shall not result in an enrollee being denied coverage of, and timely access to, any service or services excluded from their benefits package as a result of their employer's or another individual's exercise of the conscience clause outlined in subsection (1) of this section.

(3) The health care authority shall define the process through which certified health plans may offer the minimum list of health services to individuals and organizations identified in subsections (1) and (2) of this section in accordance to the provisions of section 11(3) of this act.

PART II

GUARANTEE OF INSURANCE REFORMS

NEW SECTION. Sec. 13. The legislature intends through the enactment of Part II of this act to eliminate preexisting condition exclusions in insurance, prevent cancellation of insurance because of sickness, and allow people to change jobs without losing their health care coverage. The legislature will achieve this by: Requiring insurers to renew policies as long as the premiums are duly paid; prohibiting insurers from denying a person insurance coverage because of a preexisting condition; and allowing the insurance commissioner to assess penalties for breaches of these provisions of law.

Sec. 14. RCW 48.30.010 and 1985 c 264 s 13 are each amended to read as follows:

(1) No person engaged in the business of insurance shall engage in unfair methods of competition or in unfair or deceptive acts or practices in the conduct of such business as such methods, acts, or practices are defined pursuant to subsection (2) of this section.

(2) In addition to such unfair methods and unfair or deceptive acts or practices as are expressly defined and prohibited by this code, the commissioner may from time to time by regulation promulgated pursuant to chapter 34.05 RCW, define other methods of competition and other acts and practices in the conduct of such business reasonably found by the commissioner to be unfair or deceptive, which shall include any act or practice that has the effect of changing access to appropriate and effective health services in a manner proscribed by the laws and rules of the state of Washington.

(3) No such regulation shall be made effective prior to the expiration of thirty days after the date of the order by which it is promulgated.

(4) If the commissioner has cause to believe that any person is violating any such regulation, the commissioner may order such person to cease and desist therefrom. The commissioner shall deliver such order to such person direct or mail it to the person by registered mail with return receipt requested. If the person violates the order after expiration of ten days after the cease and desist order has been received by him or her, he or she may be fined by the commissioner a sum not to exceed two hundred and fifty dollars for each violation committed thereafter.

(5) If any such regulation is violated, the commissioner may take such other or additional action as is permitted under the insurance code for violation of a regulation.

PART III

LIMITATION OF GOVERNMENT'S ROLE IN THE HEALTH CARE SYSTEM

NEW SECTION. Sec. 15. The legislature intends to minimize the role of government in the state health care system. The legislature intends to achieve this by: Reducing the health services commission to three members and making the commission a purely advisory body; and eliminating unnecessary regulations related to certified health plans.

NEW SECTION. Sec. 16. Effective July 1, 1995, the powers and duties of the Washington health services commission are transferred as follows:

(1) To the office of the insurance commissioner: Powers and duties enumerated in RCW 43.72.040 (6)(a), (7), (12), and (21), 43.72.010(4), 43.72.160, 43.72.170, 43.72.310, and 48.43.170 as they exist in statute on January 1, 1995;

(2) To the state department of health: Powers and duties enumerated in RCW 43.72.040 (2), (4), (8) through (11), (14) through (20), (23), (28), and (30), 18.130.320, 70.170.100, and 70.170.120 as they exist in statute on January 1, 1995;

All other commission powers and duties not specifically assigned by chapter . . ., Laws of 1995 (this act) shall be terminated July 1, 1995.

NEW SECTION. Sec. 17. A new section is added to chapter 43.72 RCW to read as follows:

(1) Concurrent with the transfer set forth in section 16 of this act, the Washington health services commission shall be renamed the Washington health services advisory committee and reduced to three members to be appointed by the governor and confirmed by the senate, and shall have the following powers and duties:

(a) Oversee the implementation of chapter . . ., Laws of 1995 (this act) and related chapters of the Revised Code of Washington;

(b) Periodically make recommendations to the appropriate committees of the legislature and the governor regarding the minimum list of health services;

(c) Review and report on the use of medical savings accounts, including their impact on health of participants, and the cost of health insurance and cost shifting to, or from, other state residents who purchase insurance;

(d) Conduct a study to identify the number of children with special health care needs and the cost of providing their health care. Children with special health care needs may include children who have multiple diagnoses including birth defects, congenital heart defects, cancer, kidney disease, respiratory, metabolic and neurological problems, diabetes, sickle cell disease, HIV infection, rheumatological disorders, and posttraumatic injuries, any of which may require care for longer than a year. The commission shall make recommendations on an optimal system for managing health care services to children with special needs and report back to the legislature on their findings by January 1 1996.

(e) Administer oaths, issue subpoenas, and compel the attendance of witnesses and the production of materials relevant to the committee's duties; and

(f) Review rules prepared by the insurance commissioner, health care authority, and department of health where appropriate to ensure consistency with the policies of this act.

(2) In January 1998 the legislative budget committee shall commence a study of the necessity of the existence of the committee and report its recommendation to the appropriate committees of the legislature by December 1, 1998.

NEW SECTION. Sec. 18. A new section is added to chapter 43.72 RCW to read as follows:

The legislature does not approve the health services commission's proposed uniform benefits package, nor does it approve the proposed medical risk adjustment mechanism under RCW 43.72.040(7) and indefinitely suspends the application of medical risk adjustment mechanisms, and the application of the uniform benefits package description contained in RCW 43.72.130.

NEW SECTION. Sec. 19. The following acts or parts of acts are each repealed:

(1) RCW 48.43.020 and 1993 c 492 s 433;

(2) RCW 48.43.030 and 1993 c 492 s 434;

(3) RCW 48.43.040 and 1993 c 492 s 435;

(4) RCW 48.43.050 and 1993 c 492 s 436;

(5) RCW 48.43.060 and 1993 c 492 s 437;

(6) RCW 48.43.070 and 1993 c 492 s 438;

(7) RCW 48.43.080 and 1993 c 492 s 439;

(8) RCW 48.43.090 and 1993 c 492 s 440;

(9) RCW 48.43.100 and 1993 c 492 s 441;

(10) RCW 48.43.110 and 1993 c 492 s 442;

(11) RCW 48.43.120 and 1993 c 492 s 443;

(12) RCW 48.43.130 and 1993 c 492 s 444; and

(13) RCW 48.43.150 and 1993 c 492 s 446.

PART IV

AFFORDABLE INSURANCE

NEW SECTION. Sec. 20. The legislature intends to protect individual's, family's, and businesses' ability to maintain their health insurance and to allow those presently uninsured to purchase health insurance by making health insurance more affordable. The legislature will achieve this by allowing insurers to give limited discounts based on age and healthy lifestyle factors; allowing greater flexibility in the use of deductibles and coinsurance; by preventing self-insured companies from initially profiting from a healthier and less costly employee insurance pool and later cost-shifting if their employee insurance pool becomes less healthy and more costly; prohibiting insurers from cost-shifting from big business to small business and individuals in the sale of supplemental benefits; and permitting cooperative health care purchasing groups.

NEW SECTION. Sec. 21. In addition to the adjustments permitted to establish the "community rate" under RCW 43.72.010, certified health plans shall also be permitted to make adjustments to reflect actuarially demonstrated differences in utilization or cost attributed to age and wellness factors provided:

(1) Adjustments to the rates for a health plan permitted for age shall not result in a rate per enrollee of more than three hundred percent of the lowest rate for any enrollee in 1996, and two hundred percent thereafter. Such age adjustments shall not use age brackets smaller than five-year increments, and shall begin with age thirty and end with age sixty-five;

(2) Adjustments to the rates for a health plan permitted for wellness programs shall be limited to plus or minus ten percent;

(3) The premium charged for a health plan may not be adjusted more frequently than annually except for rate decreases, except that rates may be changed to reflect enrollment changes, changes in family composition of the enrollee, or benefit changes to the health plan requested by the employer or enrollee;

(4) Adjustment to the rates are permitted for coverage of one child; and

(5) A wellness program is an explicit program of activity consistent with department of health guidelines, such as smoking cessation, injury and accident prevention, reduction of alcohol or other drug misuse, appropriate weight reduction, exercise, automobile and motorcycle safety, blood cholesterol reduction, and nutrition education for the purpose of improving enrollee health status and reducing health service costs.

NEW SECTION. Sec. 22. A new section is added to chapter 43.72 RCW to read as follows:

The following definition applies throughout this chapter and elsewhere in statute as indicated:

"Minimum list of health services," "minimum health services list," or "minimum health services" means those health services, required to be delivered by the basic health plan on and after the effective date of this act. References to "uniform benefits package" after the effective date of this act, throughout the Revised Code of Washington shall be construed to mean "minimum list of health services."

NEW SECTION. Sec. 23. A new section is added to chapter 70.47 RCW to read as follows:

The administrator's duties under this section shall be construed to supersede and be more specific than conflicting provisions of this chapter.

The administrator shall administer a schedule of covered health services entitled the basic health plan, which shall be the physician services, inpatient and outpatient hospital services, and prescription drugs and medications that were covered by the basic health plan as of July 1, 1994, with the following additional services: Services of licensed midwives, limited chiropractic care, limited chemical dependency services, limited mental health services, and limited physical therapy. After the administrator has made the modifications to the basic health plan that are necessary to include these services, the basic health plan may not be further modified except by an act of law.

NEW SECTION. Sec. 24. Certified health plans shall not be required to sell at the "community rate" to any individual who is employed by a self-insured company, or to any company who was self-insured prior to December 31, 1995.

NEW SECTION. Sec. 25. Point of service cost sharing shall include deductibles, copayments, or coinsurance in accordance with the provisions of chapter 245-03 WAC.

NEW SECTION. Sec. 26. Each certified health plan will offer the minimum list of health services with at least two of the following set of deductible options, revised annually to account for inflation using the consumer price index and rounded to the nearest whole dollar:

(1) Zero deductible;

(2) Two hundred fifty dollars deductible for individuals, seven hundred fifty dollars deductible for families;

(3) Five hundred dollars deductible for individuals, one thousand dollars deductible for families;

(4) One thousand dollars deductible for individuals, two thousand dollars deductible for families.

NEW SECTION. Sec. 27. A new section is added to chapter 48.43 RCW to read as follows:

Any group of individuals may form a cooperative health care purchasing group. In addition to and separate from the authority of health insurance purchasing cooperatives:

(1) Every cooperative health care purchasing group shall:

(a) Admit all individuals, employers, or other groups wishing to participate that meet individual purchasing group requirements;

(b) Be operated as a member-governed and owned, nonprofit organization in which no certified health plan, 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 organization;

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

(2) No purchasing group may bear any financial risk for the delivery of services within the minimum list of health services, or for any other insurance or health services program.

(3) Every purchasing group shall offer members the minimum list of health services as the minimum available health plan. The purchasing group may negotiate with certified health plans the premium to be paid by members for the minimum list of health services, but the rate must be filed and approved by the commissioner.

(4) When more than one plan's minimum list of health services package is offered by the purchasing group, every purchasing group may assist members in selecting health plans and for this purpose may devise a rating system or similar system to judge the quality and cost-effectiveness of competing plans. Each purchasing group and directors, officers, and other employees of the group 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 health 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) The commissioner may adopt rules necessary for the implementation of this section.

(6) The commissioner may recommend to interested parties ways in which purchasing groups can develop, encourage, and provide incentives for employee wellness programs.

PART V

UNIVERSAL ACCESS THROUGH INCENTIVES

NEW SECTION. Sec. 28. The legislature maintains the fundamental goal that all Washingtonians should have access to health insurance and intends to achieve universal access through incentives rather than an employer mandate. The legislature intends to do this by: Expanding the existing basic health plan to two hundred thousand enrollees; expanding the availability of medicaid to an additional one hundred twenty-five thousand children; giving preference in state government contracts to employers who provide health insurance to their employees; allowing employers to sign up for basic health plan health insurance through their periodic filings with the department of labor and industries; fully integrating worker's compensation medical benefits into a consolidated state health care system once the uninsured population is less than four percent; and eliminating the employer mandate.

NEW SECTION. Sec. 29. The sum of . . . . . . dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1997, from the health services account to the basic health plan to expand basic health plan enrollment to a total of at least two hundred thousand individuals, including at least one hundred thousand employer sponsored individuals.

NEW SECTION. Sec. 30. In addition to other moneys appropriated to the department of social and health services for medical assistance, the sum of . . . . . . dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1997, from the health services account to the department of social and health services, to serve an additional one hundred twenty-five thousand children.

NEW SECTION. Sec. 31. The health care authority, the office of financial management, and the state treasurer shall together monitor the enrollee level in the basic health plan and medicaid and adjust the funding levels by transfers of funds between the basic health plan subscription accounts and the medicaid dollars appropriated in sections 29 and 30 of this act to maximize enrollment.

NEW SECTION. Sec. 32. A new section is added to chapter 43.19 RCW to read as follows:

Any person, firm, or organization that makes any bid to provide any goods or any services to any state agency shall be granted a preference over other bidders if the vendor provides the minimum list of health services as defined in chapter 43.72 RCW to ninety-five percent of their employees. The preference provided under this section shall be equal to ten percent of the total bid amount. For purposes of this section employees of under three months are not included in the computation.

NEW SECTION. Sec. 33. A new section is added to Title 51 RCW to read as follows:

The department of labor and industries and the health care authority shall develop an easy employer payment method for the basic health plan under which an employer can make his or her basic health plan payment on the same forms and in the same check he or she uses to make workers' compensation payments.

NEW SECTION. Sec. 34. Insurance brokers, agents, and solicitors shall be entitled to sell the basic health plan and shall receive from the health care authority a three percent commission for each individual sale of the basic health plan to anyone not previously signed up and a one percent commission for each group sale of the basic health plan. No commission shall be provided upon a renewal. Commissions shall be determined based on the estimated annual cost of the basic health plan. The health care authority shall use moneys in the basic health plan trust account for this purpose.

NEW SECTION. Sec. 35. The legislature finds that assuring adequate access to quality health services in rural and medically underserved areas requires special efforts to recruit and train health service providers and the development of health care systems in these areas. The state department of health has provided valuable coordination and technical assistance in these efforts through its office of rural health. The University of Washington's rural and underserved opportunities program and its community health systems development program have voluntarily initiated various creative efforts, which have made solid progress in meeting these essential state needs, despite the lack of explicit financial support from state government for these purposes. The legislature recognizes that increased price competition in health services delivery may jeopardize the University of Washington's laudatory efforts in these areas, and in other teaching and research endeavors that are critical to promoting universal access to quality health services. Therefore, the department of health is authorized to ensure the continuation of these efforts as well as their coordination in the context of overall health systems development, within funds specially appropriated for this purpose.

There is appropriated to the department of health from the health services account, the amount of five hundred thousand dollars for the 1995-1997 biennium to contract with the University of Washington to support community health systems development services and rural and underserved health provider opportunities in communities targeted by the department of health in consultation with selected local health jurisdictions and hospital districts in rural and medically underserved areas. This contract may contain no more than a ten percent indirect cost, overhead, or administrative allocation to the University of Washington. No less than fifty percent of the funds provided in this section must support expanded efforts in these areas.

NEW SECTION. Sec. 36. The following acts or parts of acts are each repealed:

(1) RCW 43.72.220 and 1993 c 494 s 3 & 1993 c 492 s 464;

(2) RCW 43.72.240 and 1993 c 494 s 4 & 1993 c 492 s 466;

(3) RCW 43.72.810 and 1993 c 492 s 474;

(4) RCW 43.72.210 and 1993 c 492 s 463; and

(5) RCW 43.72.120 and 1993 c 492 s 430.

NEW SECTION. Sec. 37. Section 4 of this act shall constitute a new chapter in Title 48 RCW.

NEW SECTION. Sec. 38. Part headings as used in this act constitute no part of the law.

NEW SECTION. Sec. 39. 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 July 1, 1995.