BILL REQ. #: H-3176.1
State of Washington | 61st Legislature | 2009 Regular Session |
Read first time 04/13/09. Referred to Committee on Ways & Means.
AN ACT Relating to changes in the basic health plan program necessary to implement the 2009-2011 operating budget; amending RCW 70.47.010, 70.47.020, 70.47.060, 70.47.100, and 74.09.053; and repealing RCW 70.47.170.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 70.47.010 and 2000 c 79 s 42 are each amended to read
as follows:
(1)(a) The legislature finds that limitations on access to health
care services for enrollees in the state, such as in rural and
underserved areas, are particularly challenging for the basic health
plan. Statutory restrictions have reduced the options available to the
administrator to address the access needs of basic health plan
enrollees. It is the intent of the legislature to authorize the
administrator to develop alternative purchasing strategies to ensure
access to basic health plan enrollees in all areas of the state,
including: (i) The use of differential rating for managed health care
systems based on geographic differences in costs; and (ii) limited use
of self-insurance in areas where adequate access cannot be assured
through other options.
(b) In developing alternative purchasing strategies to address
health care access needs, the administrator shall consult with
interested persons including health carriers, health care providers,
and health facilities, and with other appropriate state agencies
including the office of the insurance commissioner and the office of
community and rural health. In pursuing such alternatives, the
administrator shall continue to give priority to prepaid managed care
as the preferred method of assuring access to basic health plan
enrollees followed, in priority order, by preferred providers, fee for
service, and self-funding.
(2) The legislature further finds that:
(a) A significant percentage of the population of this state does
not have reasonably available insurance or other coverage of the costs
of necessary basic health care services;
(b) This lack of basic health care coverage is detrimental to the
health of the individuals lacking coverage and to the public welfare,
and results in substantial expenditures for emergency and remedial
health care, often at the expense of health care providers, health care
facilities, and all purchasers of health care, including the state; and
(c) The use of managed health care systems has significant
potential to reduce the growth of health care costs incurred by the
people of this state generally, and by low-income pregnant women, and
at-risk children and adolescents who need greater access to managed
health care.
(3) The purpose of this chapter is to provide or make more readily
available necessary basic health care services in an appropriate
setting to working persons and others who lack coverage, at a cost to
these persons that does not create barriers to the utilization of
necessary health care services. To that end, this chapter establishes
a program to be made available to those residents not eligible for
medicare who share in a portion of the cost or who pay the full cost of
receiving basic health care services from a managed health care system.
(4) It is not the intent of this chapter to provide health care
services for those persons who are presently covered through private
employer-based health plans, nor to replace employer-based health
plans. However, the legislature recognizes that cost-effective and
affordable health plans may not always be available to small business
employers. Further, it is the intent of the legislature to expand,
wherever possible, the availability of private health care coverage and
to discourage the decline of employer-based coverage.
(5)(a) It is the purpose of this chapter to acknowledge the initial
success of this program that has (i) assisted thousands of families in
their search for affordable health care; (ii) demonstrated that low-income, uninsured families are willing to pay for their own health care
coverage to the extent of their ability to pay; and (iii) proved that
local health care providers are willing to enter into a public-private
partnership as a managed care system.
(b) As a consequence, the legislature intends to extend an option
to enroll to certain citizens above two hundred percent of the federal
poverty guidelines within the state who reside in communities where the
plan is operational and who collectively or individually wish to
exercise the opportunity to purchase health care coverage through the
basic health plan if the purchase is done at no cost to the state. It
is also the intent of the legislature to allow employers and other
financial sponsors to financially assist such individuals to purchase
health care through the program so long as such purchase does not
result in a lower standard of coverage for employees.
(c) The legislature intends that, to the extent of available funds,
the program be available throughout Washington state to subsidized and
nonsubsidized enrollees. It is also the intent of the legislature to
enroll subsidized enrollees first, to the maximum extent feasible.
(d) The legislature directs that the basic health plan
administrator identify enrollees who are likely to be eligible for
medical assistance and assist these individuals in applying for and
receiving medical assistance. The administrator and the department of
social and health services shall implement a seamless system to
coordinate eligibility determinations and benefit coverage for
enrollees of the basic health plan and medical assistance recipients.
Enrollees receiving medical assistance are not eligible for the
Washington basic health plan.
Sec. 2 RCW 70.47.020 and 2007 c 259 s 35 are each amended to read
as follows:
As used in this chapter:
(1) "Washington basic health plan" or "plan" means the system of
enrollment and payment 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) "Health coverage tax credit program" means the program created
by the Trade Act of 2002 (P.L. 107-210) that provides a federal tax
credit that subsidizes private health insurance coverage for displaced
workers certified to receive certain trade adjustment assistance
benefits and for individuals receiving benefits from the pension
benefit guaranty corporation.
(4) "Health coverage tax credit eligible enrollee" means individual
workers and their qualified family members who lose their jobs due to
the effects of international trade and are eligible for certain trade
adjustment assistance benefits; or are eligible for benefits under the
alternative trade adjustment assistance program; or are people who
receive benefits from the pension benefit guaranty corporation and are
at least fifty-five years old.
(5) "Managed health care system" means: (a) 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, to a defined patient population enrolled in the
plan and in the managed health care system; or (b) a self-funded or
self-insured method of providing insurance coverage to subsidized
enrollees provided under RCW 41.05.140 and subject to the limitations
under RCW 70.47.100(7).
(6) "Subsidized enrollee" means:
(a) An individual, or an individual plus the individual's spouse or
dependent children:
(i) Who is not eligible for medicare;
(ii) Who is not confined or residing in a government-operated
institution, unless he or she meets eligibility criteria adopted by the
administrator;
(iii) Who is not a full-time student who has received a temporary
visa to study in the United States;
(iv) Who resides in an area of the state served by a managed health
care system participating in the plan;
(v) Whose gross family income at the time of enrollment does not
exceed two hundred percent of the federal poverty level as adjusted for
family size and determined annually by the federal department of health
and human services; ((and))
(vi) Who chooses to obtain basic health care coverage from a
particular managed health care system in return for periodic payments
to the plan; and
(vii) Who is not receiving medical assistance administered by the
department of social and health services;
(b) An individual who meets the requirements in (a)(i) through (iv)
((and)), (vi), and (vii) of this subsection and who is a foster parent
licensed under chapter 74.15 RCW and whose gross family income at the
time of enrollment does not exceed three hundred percent of the federal
poverty level as adjusted for family size and determined annually by
the federal department of health and human services; and
(c) To the extent that state funds are specifically appropriated
for this purpose, with a corresponding federal match, an individual, or
an individual's spouse or dependent children, who meets the
requirements in (a)(i) through (iv) ((and)), (vi), and (vii) of this
subsection and whose gross family income at the time of enrollment is
more than two hundred percent, but less than two hundred fifty-one
percent, of the federal poverty level as adjusted for family size and
determined annually by the federal department of health and human
services.
(7) "Nonsubsidized enrollee" means an individual, or an individual
plus the individual's spouse or dependent children: (a) Who is not
eligible for medicare; (b) who is not confined or residing in a
government-operated institution, unless he or she meets eligibility
criteria adopted by the administrator; (c) who is accepted for
enrollment by the administrator as provided in RCW 48.43.018, either
because the potential enrollee cannot be required to complete the
standard health questionnaire under RCW 48.43.018, or, based upon the
results of the standard health questionnaire, the potential enrollee
would not qualify for coverage under the Washington state health
insurance pool; (d) who resides in an area of the state served by a
managed health care system participating in the plan; (e) who chooses
to obtain basic health care coverage from a particular managed health
care system; and (f) who pays or on whose behalf is paid the full costs
for participation in the plan, without any subsidy from the plan.
(8) "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).
(9) "Premium" means a periodic payment, which an individual, their
employer or another financial sponsor makes to the plan as
consideration for enrollment in the plan as a subsidized enrollee, a
nonsubsidized enrollee, or a health coverage tax credit eligible
enrollee.
(10) "Rate" means the amount, negotiated by the administrator with
and paid to a participating managed health care system, that is based
upon the enrollment of subsidized, nonsubsidized, and health coverage
tax credit eligible enrollees in the plan and in that system.
Sec. 3 RCW 70.47.060 and 2007 c 259 s 36 are each amended to read
as follows:
The administrator has the following powers and duties:
(1) To design and from time to time revise a schedule of covered
basic health care services, including physician services, inpatient and
outpatient hospital services, prescription drugs and medications, and
other services that may be necessary for basic health care. In
addition, the administrator may, to the extent that funds are
available, offer as basic health plan services chemical dependency
services, mental health services, and organ transplant services((;
however, no one service or any combination of these three services
shall increase the actuarial value of the basic health plan benefits by
more than five percent excluding inflation, as determined by the office
of financial management)). All subsidized and nonsubsidized enrollees
in any participating managed health care system under the Washington
basic health plan shall be entitled to receive covered basic health
care services in return for premium payments to the plan. The
administrator may utilize factors including smoking status or obesity
as a differential status in premium rating for the provision of basic
health services and contract for incentive programs for smoking
cessation or obesity management. The schedule of services shall
emphasize proven preventive and primary health care and shall include
all services necessary for prenatal, postnatal, and well-child care.
However, with respect to coverage for subsidized enrollees who are
eligible to receive prenatal and postnatal services through the medical
assistance program under chapter 74.09 RCW, the administrator shall not
contract for such services except to the extent that such services are
necessary over not more than a one-month period in order to maintain
continuity of care after diagnosis of pregnancy by the managed care
provider. The schedule of services shall also include a separate
schedule of basic health care services for children, eighteen years of
age and younger, for those subsidized or nonsubsidized enrollees who
choose to secure basic coverage through the plan only for their
dependent children. In designing and revising the schedule of
services, the administrator shall consider the guidelines for assessing
health services under the mandated benefits act of 1984, RCW 48.47.030,
and such other factors as the administrator deems appropriate. The
administrator may mandate that enrollees continually enrolled on basic
health for a period of one year or more must complete a health risk
assessment and participate in programs approved by the administrator
that may include wellness and chronic disease management programs in
order to maintain basic health coverage. Accounts with breaks in
coverage not exceeding a single month at any one time are considered
continually enrolled. In approving programs, the administrator shall
consider evidence that any such programs are proven to improve enrollee
health status.
(2)(a) To design and implement a structure of periodic premiums due
the administrator from subsidized enrollees that is based upon gross
family income, giving appropriate consideration to family size and the
ages of all family members. The enrollment of children shall not
require the enrollment of their parent or parents who are eligible for
the plan. The structure of periodic premiums shall be applied to
subsidized enrollees entering the plan as individuals pursuant to
subsection (11) of this section and to the share of the cost of the
plan due from subsidized enrollees entering the plan as employees
pursuant to subsection (12) of this section.
(b) To determine the periodic premiums due the administrator from
subsidized enrollees under RCW 70.47.020(6)(b). Premiums due for
foster parents with gross family income up to two hundred percent of
the federal poverty level shall be set at the minimum premium amount
charged to enrollees with income below sixty-five percent of the
federal poverty level. Premiums due for foster parents with gross
family income between two hundred percent and three hundred percent of
the federal poverty level shall not exceed one hundred dollars per
month.
(c) To determine the periodic premiums due the administrator from
nonsubsidized enrollees. Premiums due from nonsubsidized enrollees
shall be in an amount equal to the cost charged by the managed health
care system provider to the state for the plan plus the administrative
cost of providing the plan to those enrollees and the premium tax under
RCW 48.14.0201.
(d) To determine the periodic premiums due the administrator from
health coverage tax credit eligible enrollees. Premiums due from
health coverage tax credit eligible enrollees must be in an amount
equal to the cost charged by the managed health care system provider to
the state for the plan, plus the administrative cost of providing the
plan to those enrollees and the premium tax under RCW 48.14.0201. The
administrator will consider the impact of eligibility determination by
the appropriate federal agency designated by the Trade Act of 2002
(P.L. 107-210) as well as the premium collection and remittance
activities by the United States internal revenue service when
determining the administrative cost charged for health coverage tax
credit eligible enrollees.
(e) An employer or other financial sponsor may, with the prior
approval of the administrator, pay the premium, rate, or any other
amount on behalf of a subsidized or nonsubsidized enrollee, by
arrangement with the enrollee and through a mechanism acceptable to the
administrator. The administrator shall establish a mechanism for
receiving premium payments from the United States internal revenue
service for health coverage tax credit eligible enrollees.
(f) To develop, as an offering by every health carrier providing
coverage identical to the basic health plan, as configured on January
1, 2001, a basic health plan model plan with uniformity in enrollee
cost-sharing requirements.
(3) To evaluate, with the cooperation of participating managed
health care system providers, the impact on the basic health plan of
enrolling health coverage tax credit eligible enrollees. The
administrator shall issue to the appropriate committees of the
legislature preliminary evaluations on June 1, 2005, and January 1,
2006, and a final evaluation by June 1, 2006. The evaluation shall
address the number of persons enrolled, the duration of their
enrollment, their utilization of covered services relative to other
basic health plan enrollees, and the extent to which their enrollment
contributed to any change in the cost of the basic health plan.
(4) To end the participation of health coverage tax credit eligible
enrollees in the basic health plan if the federal government reduces or
terminates premium payments on their behalf through the United States
internal revenue service.
(5) To design and implement a structure of enrollee cost-sharing
due a managed health care system from subsidized, nonsubsidized, and
health coverage tax credit eligible enrollees. The structure shall
discourage inappropriate enrollee utilization of health care services,
and may utilize copayments, deductibles, and other cost-sharing
mechanisms, but shall not be so costly to enrollees as to constitute a
barrier to appropriate utilization of necessary health care services.
(6) To limit enrollment of persons who qualify for subsidies so as
to prevent an overexpenditure of appropriations for such purposes.
Whenever the administrator finds that there is danger of such an
overexpenditure, the administrator shall close enrollment until the
administrator finds the danger no longer exists. Such a closure does
not apply to health coverage tax credit eligible enrollees who receive
a premium subsidy from the United States internal revenue service as
long as the enrollees qualify for the health coverage tax credit
program. To prevent the risk of overexpenditure, the administrator may
disenroll persons receiving subsidies from the program based on
criteria adopted by the administrator. The criteria may include:
Length of continual enrollment on the program, income level, or
eligibility for other coverage. The administrator shall develop
criteria for persons disenrolled under this subsection to reapply for
the program.
(7) To limit the payment of subsidies to subsidized enrollees, as
defined in RCW 70.47.020. The level of subsidy provided to persons who
qualify may be based on the lowest cost plans, as defined by the
administrator.
(8) To adopt a schedule for the orderly development of the delivery
of services and availability of the plan to residents of the state,
subject to the limitations contained in RCW 70.47.080 or any act
appropriating funds for the plan.
(9) To solicit and accept applications from managed health care
systems, as defined in this chapter, for inclusion as eligible basic
health care providers under the plan for subsidized enrollees,
nonsubsidized enrollees, or health coverage tax credit eligible
enrollees. The administrator shall endeavor to assure that covered
basic health care services are available to any enrollee of the plan
from among a selection of two or more participating managed health care
systems. In adopting any rules or procedures applicable to managed
health care systems and in its dealings with such systems, the
administrator shall consider and make suitable allowance for the need
for health care services and the differences in local availability of
health care resources, along with other resources, within and among the
several areas of the state. Contracts with participating managed
health care systems shall ensure that basic health plan enrollees who
become eligible for medical assistance may, at their option, continue
to receive services from their existing providers within the managed
health care system if such providers have entered into provider
agreements with the department of social and health services.
(10) To receive periodic premiums from or on behalf of subsidized,
nonsubsidized, and health coverage tax credit eligible enrollees,
deposit them in the basic health plan operating account, keep records
of enrollee status, and authorize periodic payments to managed health
care systems on the basis of the number of enrollees participating in
the respective managed health care systems.
(11) To accept applications from individuals residing in areas
served by the plan, on behalf of themselves and their spouses and
dependent children, for enrollment in the Washington basic health plan
as subsidized, nonsubsidized, or health coverage tax credit eligible
enrollees, to give priority to members of the Washington national guard
and reserves who served in Operation Enduring Freedom, Operation Iraqi
Freedom, or Operation Noble Eagle, and their spouses and dependents,
for enrollment in the Washington basic health plan, to establish
appropriate minimum-enrollment periods for enrollees as may be
necessary, and to determine, upon application and on a reasonable
schedule defined by the authority, or at the request of any enrollee,
eligibility due to current gross family income for sliding scale
premiums. Funds received by a family as part of participation in the
adoption support program authorized under RCW 26.33.320 and 74.13.100
through 74.13.145 shall not be counted toward a family's current gross
family income for the purposes of this chapter. When an enrollee fails
to report income or income changes accurately, the administrator shall
have the authority either to bill the enrollee for the amounts overpaid
by the state or to impose civil penalties of up to two hundred percent
of the amount of subsidy overpaid due to the enrollee incorrectly
reporting income. The administrator shall adopt rules to define the
appropriate application of these sanctions and the processes to
implement the sanctions provided in this subsection, within available
resources. No subsidy may be paid with respect to any enrollee whose
current gross family income exceeds twice the federal poverty level or,
subject to RCW 70.47.110, who is a recipient of medical assistance or
medical care services under chapter 74.09 RCW. If a number of
enrollees drop their enrollment for no apparent good cause, the
administrator may establish appropriate rules or requirements that are
applicable to such individuals before they will be allowed to reenroll
in the plan.
(12) To accept applications from business owners on behalf of
themselves and their employees, spouses, and dependent children, as
subsidized or nonsubsidized enrollees, who reside in an area served by
the plan. The administrator may require all or the substantial
majority of the eligible employees of such businesses to enroll in the
plan and establish those procedures necessary to facilitate the orderly
enrollment of groups in the plan and into a managed health care system.
The administrator may require that a business owner pay at least an
amount equal to what the employee pays after the state pays its portion
of the subsidized premium cost of the plan on behalf of each employee
enrolled in the plan. Enrollment is limited to those not eligible for
medicare who wish to enroll in the plan and choose to obtain the basic
health care coverage and services from a managed care system
participating in the plan. The administrator shall adjust the amount
determined to be due on behalf of or from all such enrollees whenever
the amount negotiated by the administrator with the participating
managed health care system or systems is modified or the administrative
cost of providing the plan to such enrollees changes.
(13) To determine the rate to be paid to each participating managed
health care system in return for the provision of covered basic health
care services to enrollees in the system. Although the schedule of
covered basic health care services will be the same or actuarially
equivalent for similar enrollees, the rates negotiated with
participating managed health care systems may vary among the systems.
In negotiating rates with participating systems, the administrator
shall consider the characteristics of the populations served by the
respective systems, economic circumstances of the local area, the need
to conserve the resources of the basic health plan trust account, and
other factors the administrator finds relevant.
(14) To monitor the provision of covered services to enrollees by
participating managed health care systems in order to assure enrollee
access to good quality basic health care, to require periodic data
reports concerning the utilization of health care services rendered to
enrollees in order to provide adequate information for evaluation, and
to inspect the books and records of participating managed health care
systems to assure compliance with the purposes of this chapter. In
requiring reports from participating managed health care systems,
including data on services rendered enrollees, the administrator shall
endeavor to minimize costs, both to the managed health care systems and
to the plan. The administrator shall coordinate any such reporting
requirements with other state agencies, such as the insurance
commissioner and the department of health, to minimize duplication of
effort.
(15) To evaluate the effects this chapter has on private employer-based health care coverage and to take appropriate measures consistent
with state and federal statutes that will discourage the reduction of
such coverage in the state.
(16) To develop a program of proven preventive health measures and
to integrate it into the plan wherever possible and consistent with
this chapter.
(17) To provide, consistent with available funding, assistance for
rural residents, underserved populations, and persons of color.
(18) In consultation with appropriate state and local government
agencies, to establish criteria defining eligibility for persons
confined or residing in government-operated institutions.
(19) To administer the premium discounts provided under RCW
48.41.200(3)(a) (i) and (ii) pursuant to a contract with the Washington
state health insurance pool.
(20) To give priority in enrollment to persons who disenrolled from
the program in order to enroll in medicaid, and subsequently became
ineligible for medicaid coverage.
Sec. 4 RCW 70.47.100 and 2004 c 192 s 4 are each amended to read
as follows:
(1) A managed health care system participating in the plan shall do
so by contract with the administrator and shall provide, directly or by
contract with other health care providers, covered basic health care
services to each enrollee covered by its contract with the
administrator as long as payments from the administrator on behalf of
the enrollee are current. A participating managed health care system
may offer, without additional cost, health care benefits or services
not included in the schedule of covered services under the plan. A
participating managed health care system shall not give preference in
enrollment to enrollees who accept such additional health care benefits
or services. Managed health care systems participating in the plan
shall not discriminate against any potential or current enrollee based
upon health status, sex, race, ethnicity, or religion. The
administrator may receive and act upon complaints from enrollees
regarding failure to provide covered services or efforts to obtain
payment, other than authorized copayments, for covered services
directly from enrollees, but nothing in this chapter empowers the
administrator to impose any sanctions under Title 18 RCW or any other
professional or facility licensing statute.
(2) The plan shall allow, at least annually, an opportunity for
enrollees to transfer their enrollments among participating managed
health care systems serving their respective areas. The administrator
shall establish a period of at least twenty days in a given year when
this opportunity is afforded enrollees, and in those areas served by
more than one participating managed health care system the
administrator shall endeavor to establish a uniform period for such
opportunity. The plan shall allow enrollees to transfer their
enrollment to another participating managed health care system at any
time upon a showing of good cause for the transfer.
(3) Prior to negotiating with any managed health care system, the
administrator shall determine, on an actuarially sound basis, the
reasonable cost of providing the schedule of basic health care
services, expressed in terms of upper and lower limits, and recognizing
variations in the cost of providing the services through the various
systems and in different areas of the state.
(4) In negotiating with managed health care systems for
participation in the plan, the administrator shall adopt a uniform
procedure that includes at least the following:
(a) The administrator shall issue a request for proposals,
including standards regarding the quality of services to be provided;
financial integrity of the responding systems; and responsiveness to
the unmet health care needs of the local communities or populations
that may be served;
(b) The administrator shall then review responsive proposals and
may negotiate with respondents to the extent necessary to refine any
proposals;
(c) The administrator may then select one or more systems to
provide the covered services within a local area; and
(d) The administrator may adopt a policy that gives preference to
respondents, such as nonprofit community health clinics, that have a
history of providing quality health care services to low-income
persons.
(5) The administrator may contract with a managed health care
system to provide covered basic health care services to subsidized
enrollees, nonsubsidized enrollees, health coverage tax credit eligible
enrollees, or any combination thereof.
(6) The administrator may establish procedures and policies to
further negotiate and contract with managed health care systems
following completion of the request for proposal process in subsection
(4) of this section, upon a determination by the administrator that it
is necessary to provide access, as defined in the request for proposal
documents, to covered basic health care services for enrollees.
(7)(((a))) The administrator ((shall)) may implement a self-funded
or self-insured method of providing insurance coverage to subsidized
enrollees, as provided under RCW 41.05.140((, if one of the following
conditions is met:)). Prior to implementing a self-funded or self-insured
method, the administrator shall ensure that funding available in the
basic health plan self-insurance reserve account is sufficient for the
self-funded or self-insured risk assumed, or expected to be assumed, by
the administrator. If implementing a self-funded or self-insured
method, the administrator may request funds to be moved from the basic
health plan trust account or the basic health plan subscription account
to the basic health plan self-insurance reserve account established in
RCW 41.05.140.
(i) The authority determines that no managed health care system
other than the authority is willing and able to provide access, as
defined in the request for proposal documents, to covered basic health
care services for all subsidized enrollees in an area; or
(ii) The authority determines that no other managed health care
system is willing to provide access, as defined in the request for
proposal documents, for one hundred thirty-three percent of the
statewide benchmark price or less, and the authority is able to offer
such coverage at a price that is less than the lowest price at which
any other managed health care system is willing to provide such access
in an area.
(b) The authority shall initiate steps to provide the coverage
described in (a) of this subsection within ninety days of making its
determination that the conditions for providing a self-funded or self-insured method of providing insurance have been met.
(c) The administrator may not implement a self-funded or self-insured method of providing insurance in an area unless the
administrator has received a certification from a member of the
American academy of actuaries that the funding available in the basic
health plan self-insurance reserve account is sufficient for the self-funded or self-insured risk assumed, or expected to be assumed, by the
administrator
Sec. 5 RCW 74.09.053 and 2006 c 264 s 2 are each amended to read
as follows:
(1) The department of social and health services((, in coordination
with the health care authority,)) shall by November 15th of each year
report to the legislature:
(a) The number of medical assistance recipients who: (i) Upon
enrollment or recertification had reported being employed, and
beginning with the 2008 report, the month and year they reported being
hired; or (ii) upon enrollment or recertification had reported being
the dependent of someone who was employed, and beginning with the 2008
report, the month and year they reported the employed person was hired.
For recipients identified under (a)(i) and (ii) of this subsection, the
department shall report the basis for their medical assistance
eligibility, including but not limited to family medical coverage,
transitional medical assistance, children's medical or aged or
((disabled)) individuals with disabilities coverage; member months; and
the total cost to the state for these recipients, expressed as general
fund-state, health services account and general fund-federal dollars.
The information shall be reported by employer (([size])) size for
employers having more than fifty employees as recipients or with
dependents as recipients. This information shall be provided for the
preceding January and June of that year.
(b) The following aggregated information: (i) The number of
employees who are recipients or with dependents as recipients by
private and governmental employers; (ii) the number of employees who
are recipients or with dependents as recipients by employer size for
employers with fifty or fewer employees, fifty-one to one hundred
employees, one hundred one to one thousand employees, one thousand one
to five thousand employees and more than five thousand employees; and
(iii) the number of employees who are recipients or with dependents as
recipients by industry type.
(([(2)])) (2) For each aggregated classification, the report will
include the number of hours worked, the number of department of social
and health services covered lives, and the total cost to the state for
these recipients. This information shall be for each quarter of the
preceding year.
NEW SECTION. Sec. 6 RCW 70.47.170 (Annual reporting requirement)
and 2006 c 264 s 1 are each repealed.