H-2526.1  _______________________________________________

                    SUBSTITUTE HOUSE BILL 2226

          _______________________________________________

State of Washington      55th Legislature     1997 Regular Session

By House Committee on Health Care (originally sponsored by Representatives Dyer, Cody, Cooke, Crouse, Sheahan, Clements, Alexander, Wensman, Sehlin, Carlson, Talcott, D. Schmidt, Benson, Regala, Tokuda, Anderson, Wood, Hatfield, Kessler, Blalock, Backlund and Kenney)

Read first time 03/05/97.

Establishing residency requirements for subsidized enrollees in the basic health plan.

    AN ACT Relating to residency requirements for subsidized enrollees in the basic health plan; and reenacting and amending RCW 70.47.020.

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

    Sec. 1.  RCW 70.47.020 and 1995 c 266 s 2 and 1995 c 2 s 3 are each reenacted and amended to read as follows:

    As used in this chapter:

    (1) "Washington basic health plan" or "plan" means the system of enrollment and payment on a prepaid capitated basis for basic health care services, administered by the plan administrator through participating managed health care systems, created by this chapter.

    (2) "Administrator" means the Washington basic health plan administrator, who also holds the position of administrator of the Washington state health care authority.

    (3) "Managed health care system" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, or any combination thereof, that provides directly or by contract basic health care services, as defined by the administrator and rendered by duly licensed providers, on a prepaid capitated basis to a defined patient population enrolled in the plan and in the managed health care system.

    (4) "Subsidized enrollee" means an individual, or an individual plus the individual's spouse or dependent children, not eligible for medicare, who ((resides)) has resided for at least eleven months in an area of the state served by a managed health care system participating in the plan, whose gross family income at the time of enrollment does not exceed twice the federal poverty level as adjusted for family size and determined annually by the federal department of health and human services, and who chooses to obtain basic health care coverage from a particular managed health care system in return for periodic payments to the plan.  The administrator shall exempt seasonal workers, as defined by rule, from the residency requirements of this section.

    (5) "Nonsubsidized enrollee" means an individual, or an individual plus the individual's spouse or dependent children, not eligible for medicare, who resides in an area of the state served by a managed health care system participating in the plan, and who chooses to obtain basic health care coverage from a particular managed health care system, and who pays or on whose behalf is paid the full costs for participation in the plan, without any subsidy from the plan.

    (6) "Subsidy" means the difference between the amount of periodic payment the administrator makes to a managed health care system on behalf of a subsidized enrollee plus the administrative cost to the plan of providing the plan to that subsidized enrollee, and the amount determined to be the subsidized enrollee's responsibility under RCW 70.47.060(2).

    (7) "Premium" means a periodic payment, based upon gross family income which an individual, their employer or another financial sponsor makes to the plan as consideration for enrollment in the plan as a subsidized enrollee or a nonsubsidized enrollee.

    (8) "Rate" means the per capita amount, negotiated by the administrator with and paid to a participating managed health care system, that is based upon the enrollment of subsidized and nonsubsidized enrollees in the plan and in that system.

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