| Passed by the House April 10, 2010 Yeas 65 ________________________________________ Speaker of the House of Representatives Passed by the Senate April 10, 2010 Yeas 26 ________________________________________ President of the Senate | I, Barbara Baker, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is ENGROSSED SECOND SUBSTITUTE HOUSE BILL 2956 as passed by the House of Representatives and the Senate on the dates hereon set forth. ________________________________________ Chief Clerk | |
| Approved ________________________________________ Governor of the State of Washington | Secretary of State State of Washington |
| State of Washington | 61st Legislature | 2010 Regular Session |
READ FIRST TIME 03/01/10.
AN ACT Relating to a hospital safety net assessment for increased hospital payments to improve health care access for the citizens of Washington; amending 2009 c 564 s 209 (uncodified); reenacting and amending RCW 43.84.092; adding a new section to chapter 70.47 RCW; adding a new chapter to Title 74 RCW; creating a new section; providing an expiration date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1
(2) The legislature finds that:
(a) Washington hospitals, working with the department of social and
health services, have proposed a hospital safety net assessment to
generate additional state and federal funding for the medicaid program,
which will be used to partially restore recent inpatient and outpatient
reductions in hospital reimbursement rates and provide for an increase
in hospital payments; and
(b) The hospital safety net assessment and hospital safety net
assessment fund created in this chapter allows the state to generate
additional federal financial participation for the medicaid program and
provides for increased reimbursement to hospitals.
(3) In adopting this chapter, it is the intent of the legislature:
(a) To impose a hospital safety net assessment to be used solely
for the purposes specified in this chapter;
(b) That funds generated by the assessment shall be used solely to
augment all other funding sources and not as a substitute for any other
funds;
(c) That the total amount assessed not exceed the amount needed, in
combination with all other available funds, to support the
reimbursement rates and other payments authorized by this chapter; and
(d) To condition the assessment on receiving federal approval for
receipt of additional federal financial participation and on
continuation of other funding sufficient to maintain hospital inpatient
and outpatient reimbursement rates and small rural disproportionate
share payments at least at the levels in effect on July 1, 2009.
NEW SECTION. Sec. 2
(1) "Certified public expenditure hospital" means a hospital
participating in the department's certified public expenditure payment
program as described in WAC 388-550-4650 or successor rule.
(2) "Critical access hospital" means a hospital as described in RCW
74.09.5225.
(3) "Department" means the department of social and health
services.
(4) "Fund" means the hospital safety net assessment fund
established under section 3 of this act.
(5) "Hospital" means a facility licensed under chapter 70.41 RCW.
(6) "Long-term acute care hospital" means a hospital which has an
average inpatient length of stay of greater than twenty-five days as
determined by the department of health.
(7) "Managed care organization" means an organization having a
certificate of authority or certificate of registration from the office
of the insurance commissioner that contracts with the department under
a comprehensive risk contract to provide prepaid health care services
to eligible clients under the department's medicaid managed care
programs, including the healthy options program.
(8) "Medicaid" means the medical assistance program as established
in Title XIX of the social security act and as administered in the
state of Washington by the department of social and health services.
(9) "Medicare cost report" means the medicare cost report, form
2552-96, or successor document.
(10) "Nonmedicare hospital inpatient day" means total hospital
inpatient days less medicare inpatient days, including medicare days
reported for medicare managed care plans, as reported on the medicare
cost report, form 2552-96, or successor forms, excluding all skilled
and nonskilled nursing facility days, skilled and nonskilled swing bed
days, nursery days, observation bed days, hospice days, home health
agency days, and other days not typically associated with an acute care
inpatient hospital stay.
(11) "Prospective payment system hospital" means a hospital
reimbursed for inpatient and outpatient services provided to medicaid
beneficiaries under the inpatient prospective payment system and the
outpatient prospective payment system as defined in WAC 388-550-1050.
For purposes of this chapter, prospective payment system hospital does
not include a hospital participating in the certified public
expenditure program or a bordering city hospital located outside of the
state of Washington and in one of the bordering cities listed in WAC
388-501-0175 or successor regulation.
(12) "Psychiatric hospital" means a hospital facility licensed as
a psychiatric hospital under chapter 71.12 RCW.
(13) "Regional support network" has the same meaning as provided in
RCW 71.24.025.
(14) "Rehabilitation hospital" means a medicare-certified
freestanding inpatient rehabilitation facility.
(15) "Secretary" means the secretary of the department of social
and health services.
(16) "Small rural disproportionate share hospital payment" means a
payment made in accordance with WAC 388-550-5200 or subsequently filed
regulation.
NEW SECTION. Sec. 3
(a) Any unexpended balance in the fund at the end of a fiscal
biennium shall carry over into the following biennium and shall be
applied to reduce the amount of the assessment under section 6(1)(c) of
this act.
(b) Any amounts remaining in the fund on July 1, 2013, shall be
used to make increased payments in accordance with sections 10 and 13
of this act for any outstanding claims with dates of service prior to
July 1, 2013. Any amounts remaining in the fund after such increased
payments are made shall be refunded to hospitals, pro rata according to
the amount paid by the hospital, subject to the limitations of federal
law.
(2) All assessments, interest, and penalties collected by the
department under sections 4 and 6 of this act shall be deposited into
the fund.
(3) Disbursements from the fund may be made only as follows:
(a) Subject to appropriations and the continued availability of
other funds in an amount sufficient to maintain the level of medicaid
hospital rates in effect on July 1, 2009;
(b) Upon certification by the secretary that the conditions set
forth in section 17(1) of this act have been met with respect to the
assessments imposed under section 4 (1) and (2) of this act, the
payments provided under section 9 of this act, payments provided under
section 13(2) of this act, and any initial payments under sections 11
and 12 of this act, funds shall be disbursed in the amount necessary to
make the payments specified in those sections;
(c) Upon certification by the secretary that the conditions set
forth in section 17(1) of this act have been met with respect to the
assessments imposed under section 4(3) of this act and the payments
provided under sections 10 and 14 of this act, payments made subsequent
to the initial payments under sections 11 and 12 of this act, and
payments under section 13(3) of this act, funds shall be disbursed
periodically as necessary to make the payments as specified in those
sections;
(d) To refund erroneous or excessive payments made by hospitals
pursuant to this chapter;
(e) The sum of forty-nine million three hundred thousand dollars
per biennium may be expended in lieu of state general fund payments to
hospitals. An additional sum of seventeen million five hundred
thousand dollars for the 2009-2011 fiscal biennium may be expended in
lieu of state general fund payments to hospitals if additional federal
financial participation under section 5001 of P.L. No. 111-5 is
extended beyond December 31, 2010;
(f) The sum of one million dollars per biennium may be disbursed
for payment of administrative expenses incurred by the department in
performing the activities authorized by this chapter;
(g) To repay the federal government for any excess payments made to
hospitals from the fund if the assessments or payment increases set
forth in this chapter are deemed out of compliance with federal
statutes and regulations and all appeals have been exhausted. In such
a case, the department may require hospitals receiving excess payments
to refund the payments in question to the fund. The state in turn
shall return funds to the federal government in the same proportion as
the original financing. If a hospital is unable to refund payments,
the state shall develop a payment plan and/or deduct moneys from future
medicaid payments.
NEW SECTION. Sec. 4
(a) For the period beginning on the date the applicable conditions
under section 17(1) of this act are met through December 31, 2010:
(i) Each prospective payment system hospital shall pay an
assessment of thirty-two dollars for each annual nonmedicare hospital
inpatient day, multiplied by the number of days in the assessment
period divided by three hundred sixty-five.
(ii) Each critical access hospital shall pay an assessment of ten
dollars for each annual nonmedicare hospital inpatient day, multiplied
by the number of days in the assessment period divided by three hundred
sixty-five.
(b) For the period beginning on January 1, 2011, and ending on June
30, 2011:
(i) Each prospective payment system hospital shall pay an
assessment of forty dollars for each annual nonmedicare hospital
inpatient day, multiplied by the number of days in the assessment
period divided by three hundred sixty-five.
(ii) Each critical access hospital shall pay an assessment of ten
dollars for each annual nonmedicare hospital inpatient day, multiplied
by the number of days in the assessment period divided by three hundred
sixty-five.
(c) For the period beginning July 1, 2011, through June 30, 2013:
(i) Each prospective payment system hospital shall pay an
assessment of forty-four dollars for each annual nonmedicare hospital
inpatient day, multiplied by the number of days in the assessment
period divided by three hundred sixty-five.
(ii) Each critical access hospital shall pay an assessment of ten
dollars for each annual nonmedicare hospital inpatient day, multiplied
by the number of days in the assessment period divided by three hundred
sixty-five.
(d)(i) For purposes of (a) and (b) of this subsection, the
department shall determine each hospital's annual nonmedicare hospital
inpatient days by summing the total reported nonmedicare inpatient days
for each hospital that is not exempt from the assessment as described
in section 5 of this act for the relevant state fiscal year 2008
portions included in the hospital's fiscal year end reports 2007 and/or
2008 cost reports. The department shall use nonmedicare hospital
inpatient day data for each hospital taken from the centers for
medicare and medicaid services' hospital 2552-96 cost report data file
as of November 30, 2009, or equivalent data collected by the
department.
(ii) For purposes of (c) of this subsection, the department shall
determine each hospital's annual nonmedicare hospital inpatient days by
summing the total reported nonmedicare hospital inpatient days for each
hospital that is not exempt from the assessment under section 5 of this
act, taken from the most recent publicly available hospital 2552-96
cost report data file or successor data file available through the
centers for medicare and medicaid services, as of a date to be
determined by the department. If cost report data are unavailable from
the foregoing source for any hospital subject to the assessment, the
department shall collect such information directly from the hospital.
(2) An assessment is imposed in the amounts set forth in this
section for the purpose of funding the restoration of the rates under
sections 9(2) and 13(2)(b) of this act and funding the initial payments
under sections 11 and 12 of this act, which shall be due and payable
within thirty calendar days after the department has transmitted a
notice of assessment to hospitals. Such notice shall be transmitted
immediately upon determination by the secretary that the applicable
conditions established by section 17(1) of this act have been met.
(a) Prospective payment system hospitals.
(i) Each prospective payment system hospital shall pay an
assessment of thirty dollars for each annual nonmedicare hospital
inpatient day up to sixty thousand per year, multiplied by a ratio, the
numerator of which is the number of days between June 30, 2009, and the
day after the applicable conditions established by section 17(1) of
this act have been met and the denominator of which is three hundred
sixty-five.
(ii) Each prospective payment system hospital shall pay an
assessment of one dollar for each annual nonmedicare hospital inpatient
day over and above sixty thousand per year, multiplied by a ratio, the
numerator of which is the number of days between June 30, 2009, and the
day after the applicable conditions established by section 17(1) of
this act have been met and the denominator of which is three hundred
sixty-five.
(b) Each critical access hospital shall pay an assessment of ten
dollars for each annual nonmedicare hospital inpatient day, multiplied
by a ratio, the numerator of which is the number of days between June
30, 2009, and the day after the applicable conditions established by
section 17(1) of this act have been met and the denominator of which is
three hundred sixty-five.
(c) For purposes of this subsection, the department shall determine
each hospital's annual nonmedicare hospital inpatient days by summing
the total reported nonmedicare inpatient days for each hospital that is
not exempt from the assessment as described in section 5 of this act
for the relevant state fiscal year 2008 portions included in the
hospital's fiscal year end reports 2007 and/or 2008 cost reports. The
department shall use nonmedicare hospital inpatient day data for each
hospital taken from the centers for medicare and medicaid services'
hospital 2552-96 cost report data file as of November 30, 2009, or
equivalent data collected by the department.
(3) An assessment is imposed as set forth in this subsection for
the period February 1, 2010, through June 30, 2013, for the purpose of
funding increased hospital payments under sections 10 and 13(3) of this
act, which shall be due and payable on the first day of each calendar
quarter after the department has sent notice of the assessment to each
affected hospital, provided that the initial assessment shall be
transmitted only after the secretary has determined that the applicable
conditions established by section 17(1) of this act have been satisfied
and shall be payable no less than thirty calendar days after the
department sends notice of the amount due to affected hospitals. The
initial assessment shall include the full amount due from February 1,
2010, through the date of the notice.
(a) For the period February 1, 2010, through December 31, 2010:
(i) Prospective payment system hospitals.
(A) Each prospective payment system hospital shall pay an
assessment of one hundred nineteen dollars for each annual nonmedicare
hospital inpatient day up to sixty thousand per year, multiplied by the
number of days in the assessment period divided by three hundred sixty-five.
(B) Each prospective payment system hospital shall pay an
assessment of five dollars for each annual nonmedicare hospital
inpatient day over and above sixty thousand per year, multiplied by the
number of days in the assessment period divided by three hundred sixty-five.
(ii) Each psychiatric hospital and each rehabilitation hospital
shall pay an assessment of thirty-one dollars for each annual
nonmedicare hospital inpatient day, multiplied by the number of days in
the assessment period divided by three hundred sixty-five.
(b) For the period beginning on January 1, 2011, and ending on June
30, 2011:
(i) Prospective payment system hospitals.
(A) Each prospective payment system hospital shall pay an
assessment of one hundred fifty dollars for each annual nonmedicare
inpatient day up to sixty thousand per year, multiplied by the number
of days in the assessment period divided by three hundred sixty-five.
(B) Each prospective payment system hospital shall pay an
assessment of six dollars for each annual nonmedicare inpatient day
over and above sixty thousand per year, multiplied by the number of
days in the assessment period divided by three hundred sixty-five. The
department may adjust the assessment or the number of nonmedicare
hospital inpatient days used to calculate the assessment amount if
necessary to maintain compliance with federal statutes and regulations
related to medicaid program health care-related taxes.
(ii) Each psychiatric hospital and each rehabilitation hospital
shall pay an assessment of thirty-nine dollars for each annual
nonmedicare hospital inpatient day, multiplied by the number of days in
the assessment period divided by three hundred sixty-five.
(c) For the period beginning July 1, 2011, through June 30, 2013:
(i) Prospective payment system hospitals.
(A) Each prospective payment system hospital shall pay an
assessment of one hundred fifty-six dollars for each annual nonmedicare
hospital inpatient day up to sixty thousand per year, multiplied by the
number of days in the assessment period divided by three hundred sixty-five.
(B) Each prospective payment system hospital shall pay an
assessment of six dollars for each annual nonmedicare inpatient day
over and above sixty thousand per year, multiplied by the number of
days in the assessment period divided by three hundred sixty-five. The
department may adjust the assessment or the number of nonmedicare
hospital inpatient days if necessary to maintain compliance with
federal statutes and regulations related to medicaid program health
care-related taxes.
(ii) Each psychiatric hospital and each rehabilitation hospital
shall pay an assessment of thirty-nine dollars for each annual
nonmedicare inpatient day, multiplied by the number of days in the
assessment period divided by three hundred sixty-five.
(d)(i) For purposes of (a) and (b) of this subsection, the
department shall determine each hospital's annual nonmedicare hospital
inpatient days by summing the total reported nonmedicare inpatient days
for each hospital that is not exempt from the assessment as described
in section 5 of this act for the relevant state fiscal year 2008
portions included in the hospital's fiscal year end reports 2007 and/or
2008 cost reports. The department shall use nonmedicare hospital
inpatient day data for each hospital taken from the centers for
medicare and medicaid services' hospital 2552-96 cost report data file
as of November 30, 2009, or equivalent data collected by the
department.
(ii) For purposes of (c) of this subsection, the department shall
determine each hospital's annual nonmedicare hospital inpatient days by
summing the total reported nonmedicare hospital inpatient days for each
hospital that is not exempt from the assessment under section 5 of this
act, taken from the most recent publicly available hospital 2552-96
cost report data file or successor data file available through the
centers for medicare and medicaid services, as of a date to be
determined by the department. If cost report data are unavailable from
the foregoing source for any hospital subject to the assessment, the
department shall collect such information directly from the hospital.
(4) Notwithstanding the provisions of section 8 of this act,
nothing in this act is intended to prohibit a hospital from including
assessment amounts paid in accordance with this section on their
medicare and medicaid cost reports.
NEW SECTION. Sec. 5
(1) Hospitals owned or operated by an agency of federal or state
government, including but not limited to western state hospital and
eastern state hospital;
(2) Washington public hospitals that participate in the certified
public expenditure program;
(3) Hospitals that do not charge directly or indirectly for
hospital services; and
(4) Long-term acute care hospitals.
NEW SECTION. Sec. 6
(a) Transmittal of quarterly notices of assessment by the
department to each hospital informing the hospital of its nonmedicare
hospital inpatient days and the assessment amount due and payable.
Such quarterly notices shall be sent to each hospital at least thirty
calendar days prior to the due date for the quarterly assessment
payment.
(b) Interest on delinquent assessments at the rate specified in RCW
82.32.050.
(c) Adjustment of the assessment amounts as follows:
(i) For each fiscal year beginning July 1, 2010, the assessment
amounts under section 4 (1) and (3) of this act may be adjusted as
follows:
(A) If sufficient other funds for hospitals, excluding any
extension of section 5001 of P.L. No. 111-5, are available to support
the reimbursement rates and other payments under section 9, 10, 11, 12,
or 13 of this act without utilizing the full assessment authorized
under section 4 (1) or (3) of this act, the department shall reduce the
amount of the assessment for prospective payment system, psychiatric,
and rehabilitation hospitals proportionately to the minimum level
necessary to support those reimbursement rates and other payments.
(B) Provided that none of the conditions set forth in section 17(2)
of this act have occurred, if the department's forecasts indicate that
the assessment amounts under section 4 (1) and (3) of this act,
together with all other available funds, are not sufficient to support
the reimbursement rates and other payments under section 9, 10, 11, 12,
or 13 of this act, the department shall increase the assessment rates
for prospective payment system, psychiatric, and rehabilitation
hospitals proportionately to the amount necessary to support those
reimbursement rates and other payments, plus a contingency factor up to
ten percent of the total assessment amount.
(C) Any positive balance remaining in the fund at the end of the
fiscal year shall be applied to reduce the assessment amount for the
subsequent fiscal year.
(ii) Any adjustment to the assessment amounts pursuant to this
subsection, and the data supporting such adjustment, including but not
limited to relevant data listed in subsection (2) of this section, must
be submitted to the Washington state hospital association for review
and comment at least sixty calendar days prior to implementation of
such adjusted assessment amounts. Any review and comment provided by
the Washington state hospital association shall not limit the ability
of the Washington state hospital association or its members to
challenge an adjustment or other action by the department that is not
made in accordance with this chapter.
(2) By November 30th of each year, the department shall provide the
following data to the Washington state hospital association:
(a) The fund balance;
(b) The amount of assessment paid by each hospital;
(c) The annual medicaid fee-for-service payments for inpatient
hospital services and outpatient hospital services; and
(d) The medicaid healthy options inpatient and outpatient payments
as reported by all hospitals to the department on disproportionate
share hospital applications. The department shall amend the
disproportionate share hospital application and reporting instructions
as needed to ensure that the foregoing data is reported by all
hospitals as needed in order to comply with this subsection (2)(d).
(3) The department shall determine the number of nonmedicare
hospital inpatient days for each hospital for each assessment period.
(4) To the extent necessary, the department shall amend the
contracts between the managed care organizations and the department and
between regional support networks and the department to incorporate the
provisions of section 13 of this act. The department shall pursue
amendments to the contracts as soon as possible after the effective
date of this act. The amendments to the contracts shall, among other
provisions, provide for increased payment rates to managed care
organizations in accordance with section 13 of this act.
NEW SECTION. Sec. 7
NEW SECTION. Sec. 8
NEW SECTION. Sec. 9
(1) Restore medicaid inpatient and outpatient reimbursement rates
to levels as if the four percent medicaid inpatient and outpatient rate
reductions did not occur on July 1, 2009; and
(2) Recalculate the amount payable to each hospital that submitted
an otherwise allowable claim for inpatient and outpatient
medicaid-covered services rendered from and after July 1, 2009, up to
and including the date when the applicable conditions under section
17(1) of this act have been satisfied, as if the four percent medicaid
inpatient and outpatient rate reductions did not occur effective July
1, 2009, and, within sixty calendar days after the date upon which the
applicable conditions set forth in section 17(1) of this act have been
satisfied, remit the difference to each hospital.
NEW SECTION. Sec. 10
(a) Prospective payment system hospitals:
(i) Inpatient psychiatric services: Thirteen percent;
(ii) Inpatient services: Thirteen percent;
(iii) Outpatient services: Thirty-six and eighty-three one-hundredths percent.
(b) Harborview medical center and University of Washington medical
center:
(i) Inpatient psychiatric services: Three percent;
(ii) Inpatient services: Three percent;
(iii) Outpatient services: Twenty-one percent.
(c) Rehabilitation hospitals:
(i) Inpatient services: Thirteen percent;
(ii) Outpatient services: Thirty-six and eighty-three one-hundredths percent;
(d) Psychiatric hospitals:
(i) Inpatient psychiatric services: Thirteen percent;
(ii) Inpatient services: Thirteen percent.
(2) For claims processed for services rendered on or after February
1, 2010, but prior to satisfaction of the applicable conditions
specified in section 17(1) of this act, the department shall, within
sixty calendar days after satisfaction of those conditions, calculate
the amount payable to hospitals in accordance with this section and
remit the difference to each hospital that has submitted an otherwise
allowable claim for payment for such services.
(3) By December 1, 2012, the department will submit a study to the
legislature with recommendations on the amount of the assessments
necessary to continue to support hospital payments for the 2013-2015
biennium. The evaluation will assess medicaid hospital payments
relative to medicaid hospital costs. The study should address current
federal law, including any changes on scope of medicaid coverage,
provisions related to provider taxes, and impacts of federal health
care reform legislation. The study should also address the state's
economic forecast. Based on the forecast, the department should
recommend the amount of assessment needed to support future hospital
payments and the departmental administrative expenses. Recommendations
should be developed with the fiscal committees of the legislature,
office of financial management, and the Washington state hospital
association.
NEW SECTION. Sec. 11
NEW SECTION. Sec. 12
NEW SECTION. Sec. 13
(1) Amend medicaid-managed care and regional support network
contracts as necessary in order to ensure compliance with this chapter;
(2) With respect to the inpatient and outpatient rates established
by section 9 of this act:
(a) Upon satisfaction of the applicable conditions under section
17(1) of this act, increase payments to managed care organizations and
regional support networks as necessary to ensure that hospitals are
reimbursed in accordance with section 9(1) of this act for services
rendered from and after the date when applicable conditions under
section 17(1) of this act have been satisfied, and pay an additional
amount equal to the estimated amount of additional state taxes on
managed care organizations or regional support networks due as a result
of the payments under this section, and require managed care
organizations and regional support networks to make payments to each
hospital in accordance with section 9 of this act. The increased
payments made to hospitals pursuant to this subsection shall be in
addition to any other amounts payable to hospitals by managed care
organizations or regional support networks and shall not affect any
other payments to hospitals;
(b) Within sixty calendar days after satisfaction of the applicable
conditions under section 17(1) of this act, calculate the additional
amount due to each hospital to pay claims submitted for inpatient and
outpatient medicaid-covered services rendered from and after July 1,
2009, through the date when the applicable conditions under section
17(1) of this act have been satisfied, based on the rates required by
section 9(2) of this act, make payments to managed care organizations
and regional support networks in amounts sufficient to pay the
additional amounts due to each hospital plus an additional amount equal
to the estimated amount of additional state taxes on managed care
organizations or regional support networks due as a result of the
payments under this subsection, and require managed care organizations
and regional support networks to make payments to each hospital in
accordance with the department's calculations within forty-five
calendar days after the department disburses funds for those purposes.
(3) With respect to the inpatient and outpatient hospital rates
established by section 10 of this act:
(a) Upon satisfaction of the applicable conditions under section
17(1) of this act, increase payments to managed care organizations and
regional support networks as necessary to ensure that hospitals are
reimbursed in accordance with section 10 of this act, and pay an
additional amount equal to the estimated amount of additional state
taxes on managed care organizations or regional support networks due as
a result of the payments under this section;
(b) Require managed care organizations and regional support
networks to reimburse hospitals for hospital inpatient and outpatient
services rendered after the date that the applicable conditions under
section 17(1) of this act are satisfied at rates no lower than the
combined rates established by sections 9 and 10 of this act;
(c) Within sixty calendar days after satisfaction of the applicable
conditions under section 17(1) of this act, calculate the additional
amount due to each hospital to pay claims submitted for inpatient and
outpatient medicaid-covered services rendered from and after February
1, 2010, through the date when the applicable conditions under section
17(1) of this act are satisfied based on the rates required by section
10 of this act, make payments to managed care organizations and
regional support networks in amounts sufficient to pay the additional
amounts due to each hospital plus an additional amount equal to the
estimated amount of additional state taxes on managed care
organizations or regional support networks, and require managed care
organizations and regional support networks to make payments to each
hospital in accordance with the department's calculations within forty-five calendar days after the department disburses funds for those
purposes;
(d) Require managed care organizations that contract with health
care organizations that provide, directly or by contract, health care
services on a prepaid or capitated basis to make payments to health
care organizations for any of the hospital payments that the managed
care organizations would have been required to pay to hospitals under
this section if the managed care organizations did not contract with
those health care organizations, and require the managed care
organizations to require those health care organizations to make
equivalent payments to the hospitals that would have received payments
under this section if the managed care organizations did not contract
with the health care organizations;
(4) The department shall ensure that the increases to the medicaid
fee schedules as described in section 10 of this act are included in
the development of healthy options premiums.
(5) The department may require managed care organizations and
regional support networks to demonstrate compliance with this section.
NEW SECTION. Sec. 14
(a) Evidence-based treatment and processes shall be used to improve
health care outcomes for hospital patients;
(b) Effective purchasing strategies to improve the quality of
health care services should involve the use of common quality
improvement measures by public and private health care purchasers,
while recognizing that some measures may not be appropriate for
application to specialty pediatric, psychiatric, or rehabilitation
hospitals;
(c) Quality measures chosen for the system should be consistent
with the standards that have been developed by national quality
improvement organizations, such as the national quality forum, the
federal centers for medicare and medicaid services, or the federal
agency for healthcare research and quality. New reporting burdens to
hospitals should be minimized by giving priority to measures hospitals
are currently required to report to governmental agencies, such as the
hospital compare measures collected by the federal centers for medicare
and medicaid services;
(d) Benchmarks for each quality improvement measure should be set
at levels that are feasible for hospitals to achieve, yet represent
real improvements in quality and performance for a majority of
hospitals in Washington state; and
(e) Hospital performance and incentive payments should be designed
in a manner such that all noncritical access hospitals in Washington
are able to receive the incentive payments if performance is at or
above the benchmark score set in the system established under this
section.
(2) Upon satisfaction of the applicable conditions set forth in
section 17(1) of this act, and for state fiscal year 2013 and each
fiscal year thereafter, assessments may be increased to support an
additional one percent increase in inpatient hospital rates for
noncritical access hospitals that meet the quality incentive benchmarks
established under this section.
NEW SECTION. Sec. 15 A new section is added to chapter 70.47 RCW
to read as follows:
The increases in inpatient and outpatient reimbursement rates
included in chapter 74.--- RCW (the new chapter created in section 23
of this act) shall not be reflected in hospital payment rates for
services provided to basic health enrollees under this chapter.
NEW SECTION. Sec. 16
(2) Notwithstanding any other provision of this chapter, if a
hospital subject to the assessment imposed under this chapter ceases to
conduct hospital operations throughout a state fiscal year, the
assessment for the quarter in which the cessation occurs shall be
adjusted by multiplying the assessment computed under section 4 (1) and
(3) of this act by a fraction, the numerator of which is the number of
days during the year which the hospital conducts, operates, or
maintains the hospital and the denominator of which is three hundred
sixty-five. Immediately prior to ceasing to conduct, operate, or
maintain a hospital, the hospital shall pay the adjusted assessment for
the fiscal year to the extent not previously paid.
(3) Notwithstanding any other provision of this chapter, in the
case of a hospital that commences conducting, operating, or maintaining
a hospital that is not exempt from payment of the assessment under
section 5 of this act and that did not conduct, operate, or maintain
such hospital throughout the cost reporting year used to determine the
assessment amount, the assessment for that hospital shall be computed
on the basis of the actual number of nonmedicare inpatient days
reported to the department by the hospital on a quarterly basis. The
hospital shall be eligible to receive increased payments under this
chapter beginning on the date it commences hospital operations.
(4) Notwithstanding any other provision of this chapter, if a
hospital previously subject to assessment is sold or transferred to
another entity and remains subject to assessment, the assessment for
that hospital shall be computed based upon the cost report data
previously submitted by that hospital. The assessment shall be
allocated between the transferor and transferee based on the number of
days within the assessment period that each owned, operated, or
maintained the hospital.
NEW SECTION. Sec. 17
(a) Withdrawal of those aspects of any pending state plan
amendments previously submitted to the centers for medicare and
medicaid services that are inconsistent with this chapter, specifically
any pending state plan amendment related to the four percent rate
reductions for inpatient and outpatient hospital rates and elimination
of the small rural disproportionate share hospital payment program as
implemented July 1, 2009;
(b) Approval by the centers for medicare and medicaid services of
any state plan amendments or waiver requests that are necessary in
order to implement the applicable sections of this chapter;
(c) To the extent necessary, amendment of contracts between the
department and managed care organizations in order to implement this
chapter; and
(d) Certification by the office of financial management that
appropriations have been adopted that fully support the rates
established in this chapter for the upcoming fiscal year.
(2) This chapter does not take effect or ceases to be imposed, and
any moneys remaining in the fund shall be refunded to hospitals in
proportion to the amounts paid by such hospitals, if and to the extent
that:
(a) An appellate court or the centers for medicare and medicaid
services makes a final determination that any element of this chapter,
other than section 11 of this act, cannot be validly implemented;
(b) Medicaid inpatient or outpatient reimbursement rates for
hospitals are reduced below the combined rates established by sections
9 and 10 of this act;
(c) Except for payments to the University of Washington medical
center and harborview medical center, payments to hospitals required
under sections 9, 10, 12, and 13 of this act are not eligible for
federal matching funds;
(d) Other funding available for the medicaid program is not
sufficient to maintain medicaid inpatient and outpatient reimbursement
rates at the levels set in sections 9, 10, and 12 of this act; or
(e) The fund is used as a substitute for or to supplant other
funds, except as authorized by section 3(3)(e) of this act.
NEW SECTION. Sec. 18
(2) In the event that any portion of this chapter shall have been
validly implemented and the entire chapter is later rendered
ineffective under this section, prior assessments and payments under
the validly implemented portions shall not be affected.
(3) In the event that the payment under section 11 of this act, or
the application thereof to any hospital or circumstances does not
receive approval by the centers for medicare and medicaid services as
described in section 17(1)(b) of this act or is determined to be
unconstitutional or otherwise invalid, the amount of the assessment
shall be adjusted under section 6(1)(c) of this act.
Sec. 19 2009 c 564 s 209 (uncodified) is amended to read as
follows:
FOR THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES -- MEDICAL ASSISTANCE
PROGRAM
General Fund -- State Appropriation (FY 2010) . . . . . . . . . . . . $1,597,387,000
General Fund -- State Appropriation (FY 2011) . . . . . . . . . . . . $1,984,797,000
General Fund -- Federal Appropriation . . . . . . . . . . . . $5,210,672,000
General Fund -- Private/Local Appropriation . . . . . . . . . . . . $12,903,000
Emergency Medical Services and Trauma Care Systems
Trust Account -- State Appropriation . . . . . . . . . . . . $15,076,000
Tobacco Prevention and Control Account --
State Appropriation . . . . . . . . . . . . $3,766,000
TOTAL APPROPRIATION . . . . . . . . . . . . $8,824,601,000
The appropriations in this section are subject to the following
conditions and limitations:
(1) Based on quarterly expenditure reports and caseload forecasts,
if the department estimates that expenditures for the medical
assistance program will exceed the appropriations, the department shall
take steps including but not limited to reduction of rates or
elimination of optional services to reduce expenditures so that total
program costs do not exceed the annual appropriation authority.
(2) In determining financial eligibility for medicaid-funded
services, the department is authorized to disregard recoveries by
Holocaust survivors of insurance proceeds or other assets, as defined
in RCW 48.104.030.
(3) The legislature affirms that it is in the state's interest for
Harborview medical center to remain an economically viable component of
the state's health care system.
(4) When a person is ineligible for medicaid solely by reason of
residence in an institution for mental diseases, the department shall
provide the person with the same benefits as he or she would receive if
eligible for medicaid, using state-only funds to the extent necessary.
(5) In accordance with RCW 74.46.625, $6,000,000 of the general
fund -- federal appropriation is provided solely for supplemental
payments to nursing homes operated by public hospital districts. The
public hospital district shall be responsible for providing the
required nonfederal match for the supplemental payment, and the
payments shall not exceed the maximum allowable under federal rules.
It is the legislature's intent that the payments shall be supplemental
to and shall not in any way offset or reduce the payments calculated
and provided in accordance with part E of chapter 74.46 RCW. It is the
legislature's further intent that costs otherwise allowable for rate-setting and settlement against payments under chapter 74.46 RCW shall
not be disallowed solely because such costs have been paid by revenues
retained by the nursing home from these supplemental payments. The
supplemental payments are subject to retrospective interim and final
cost settlements based on the nursing homes' as-filed and final
medicare cost reports. The timing of the interim and final cost
settlements shall be at the department's discretion. During either the
interim cost settlement or the final cost settlement, the department
shall recoup from the public hospital districts the supplemental
payments that exceed the medicaid cost limit and/or the medicare upper
payment limit. The department shall apply federal rules for
identifying the eligible incurred medicaid costs and the medicare upper
payment limit.
(6) $1,110,000 of the general fund -- federal appropriation and
$1,105,000 of the general fund--state appropriation for fiscal year
2011 are provided solely for grants to rural hospitals. The department
shall distribute the funds under a formula that provides a relatively
larger share of the available funding to hospitals that (a) serve a
disproportionate share of low-income and medically indigent patients,
and (b) have relatively smaller net financial margins, to the extent
allowed by the federal medicaid program.
(7) $9,818,000 of the general fund--state appropriation for fiscal
year 2011, and $9,865,000 of the general fund -- federal appropriation
are provided solely for grants to nonrural hospitals. The department
shall distribute the funds under a formula that provides a relatively
larger share of the available funding to hospitals that (a) serve a
disproportionate share of low-income and medically indigent patients,
and (b) have relatively smaller net financial margins, to the extent
allowed by the federal medicaid program.
(8) The department shall continue the inpatient hospital certified
public expenditures program for the 2009-11 biennium. The program
shall apply to all public hospitals, including those owned or operated
by the state, except those classified as critical access hospitals or
state psychiatric institutions. The department shall submit reports to
the governor and legislature by November 1, 2009, and by November 1,
2010, that evaluate whether savings continue to exceed costs for this
program. If the certified public expenditures (CPE) program in its
current form is no longer cost-effective to maintain, the department
shall submit a report to the governor and legislature detailing
cost-effective alternative uses of local, state, and federal resources
as a replacement for this program. During fiscal year 2010 and fiscal
year 2011, hospitals in the program shall be paid and shall retain one
hundred percent of the federal portion of the allowable hospital cost
for each medicaid inpatient fee-for-service claim payable by medical
assistance and one hundred percent of the federal portion of the
maximum disproportionate share hospital payment allowable under federal
regulations. Inpatient medicaid payments shall be established using an
allowable methodology that approximates the cost of claims submitted by
the hospitals. Payments made to each hospital in the program in each
fiscal year of the biennium shall be compared to a baseline amount.
The baseline amount will be determined by the total of (a) the
inpatient claim payment amounts that would have been paid during the
fiscal year had the hospital not been in the CPE program based on the
reimbursement rates developed, implemented, and consistent with
policies approved in the 2009-11 biennial operating appropriations act
(chapter 564, Laws of 2009) and in effect on July 1, 2009, (b) one-half
of the indigent assistance disproportionate share hospital payment
amounts paid to and retained by each hospital during fiscal year 2005,
and (c) all of the other disproportionate share hospital payment
amounts paid to and retained by each hospital during fiscal year 2005
to the extent the same disproportionate share hospital programs exist
in the 2009-11 biennium. If payments during the fiscal year exceed the
hospital's baseline amount, no additional payments will be made to the
hospital except the federal portion of allowable disproportionate share
hospital payments for which the hospital can certify allowable match.
If payments during the fiscal year are less than the baseline amount,
the hospital will be paid a state grant equal to the difference between
payments during the fiscal year and the applicable baseline amount.
Payment of the state grant shall be made in the applicable fiscal year
and distributed in monthly payments. The grants will be recalculated
and redistributed as the baseline is updated during the fiscal year.
The grant payments are subject to an interim settlement within eleven
months after the end of the fiscal year. A final settlement shall be
performed. To the extent that either settlement determines that a
hospital has received funds in excess of what it would have received as
described in this subsection, the hospital must repay the excess
amounts to the state when requested. $6,570,000 of the general fund--state appropriation for fiscal year 2010, which is appropriated in
section 204(1) of this act, and $1,500,000 of the general fund--state
appropriation for fiscal year 2011, which is appropriated in section
204(1) of this act, are provided solely for state grants for the
participating hospitals. Sufficient amounts are appropriated in this
section for the remaining state grants for the participating hospitals.
CPE hospitals will receive the inpatient and outpatient reimbursement
rate restorations in section 9 and rate increases in section 10(1)(b)
of Engrossed Second Substitute House Bill No. 2956 (hospital safety net
assessment) funded through the hospital safety net assessment fund
rather than through the baseline mechanism specified in this section.
(9) The department is authorized to use funds appropriated in this
section to purchase goods and supplies through direct contracting with
vendors when the department determines it is cost-effective to do so.
(10) Sufficient amounts are appropriated in this section for the
department to continue podiatry services for medicaid-eligible adults.
(11) Sufficient amounts are appropriated in this section for the
department to provide an adult dental benefit that is at least
equivalent to the benefit provided in the 2003-05 biennium.
(12) $93,000 of the general fund--state appropriation for fiscal
year 2010 and $93,000 of the general fund--federal appropriation are
provided solely for the department to pursue a federal Medicaid waiver
pursuant to Second Substitute Senate Bill No. 5945 (Washington health
partnership plan). If the bill is not enacted by June 30, 2009, the
amounts provided in this subsection shall lapse.
(13) The department shall require managed health care systems that
have contracts with the department to serve medical assistance clients
to limit any reimbursements or payments the systems make to providers
not employed by or under contract with the systems to no more than the
medical assistance rates paid by the department to providers for
comparable services rendered to clients in the fee-for-service delivery
system.
(14) Appropriations in this section are sufficient for the
department to continue to fund family planning nurses in the community
services offices.
(15) The department, in coordination with stakeholders, will
conduct an analysis of potential savings in utilization of home
dialysis. The department shall present its findings to the appropriate
house of representatives and senate committees by December 2010.
(16) A maximum of $166,875,000 of the general fund--state
appropriation and $38,389,000 of the general fund--federal
appropriation may be expended in the fiscal biennium for the general
assistance-unemployable medical program, and these amounts are provided
solely for this program. Of these amounts, $10,749,000 of the general
fund--state appropriation for fiscal year 2010 and $10,892,000 of the
general fund--federal appropriation are provided solely for payments to
hospitals for providing outpatient services to low income patients who
are recipients of general assistance-unemployable. Pursuant to RCW
74.09.035, the department shall not expend for the general assistance
medical care services program any amounts in excess of the amounts
provided in this subsection.
(17) If the department determines that it is feasible within the
amounts provided in subsection (16) of this section, and without the
loss of federal disproportionate share hospital funds, the department
shall contract with the carrier currently operating a managed care
pilot project for the provision of medical care services to general
assistance-unemployable clients. Mental health services shall be
included in the services provided through the managed care system. If
the department determines that it is feasible, effective October 1,
2009, in addition to serving clients in the pilot counties, the carrier
shall expand managed care services to clients residing in at least the
following counties: Spokane, Yakima, Chelan, Kitsap, and Cowlitz. If
the department determines that it is feasible, the carrier shall
complete implementation into the remaining counties. Total per person
costs to the state, including outpatient and inpatient services and any
additional costs due to stop loss agreements, shall not exceed the per
capita payments projected for the general assistance-unemployable
eligibility category, by fiscal year, in the February 2009 medical
assistance expenditures forecast. The department, in collaboration
with the carrier, shall seek to improve the transition rate of general
assistance clients to the federal supplemental security income program.
(18) The department shall evaluate the impact of the use of a
managed care delivery and financing system on state costs and outcomes
for general assistance medical clients. Outcomes measured shall
include state costs, utilization, changes in mental health status and
symptoms, and involvement in the criminal justice system.
(19) The department shall report to the governor and the fiscal
committees of the legislature by June 1, 2010, on its progress toward
achieving a twenty percentage point increase in the generic
prescription drug utilization rate.
(20) State funds shall not be used by hospitals for advertising
purposes.
(21) The department shall seek a medicaid state plan amendment to
create a professional services supplemental payment program for
University of Washington medicine professional providers no later than
July 1, 2009. The department shall apply federal rules for identifying
the shortfall between current fee-for-service medicaid payments to
participating providers and the applicable federal upper payment limit.
Participating providers shall be solely responsible for providing the
local funds required to obtain federal matching funds. Any incremental
costs incurred by the department in the development, implementation,
and maintenance of this program will be the responsibility of the
participating providers. Participating providers will retain the full
amount of supplemental payments provided under this program, net of any
potential costs for any related audits or litigation brought against
the state. The department shall report to the governor and the
legislative fiscal committees on the prospects for expansion of the
program to other qualifying providers as soon as feasibility is
determined but no later than December 31, 2009. The report will
outline estimated impacts on the participating providers, the
procedures necessary to comply with federal guidelines, and the
administrative resource requirements necessary to implement the
program. The department will create a process for expansion of the
program to other qualifying providers as soon as it is determined
feasible by both the department and providers but no later than June
30, 2010.
(22) $9,350,000 of the general fund--state appropriation for fiscal
year 2010, $8,313,000 of the general fund--state appropriation for
fiscal year 2011, and $20,371,000 of the general fund--federal
appropriation are provided solely for development and implementation of
a replacement system for the existing medicaid management information
system. The amounts provided in this subsection are conditioned on the
department satisfying the requirements of section 902 of this act.
(23) $506,000 of the general fund--state appropriation for fiscal
year 2011 and $657,000 of the general fund--federal appropriation are
provided solely for the implementation of Second Substitute House Bill
No. 1373 (children's mental health). If the bill is not enacted by
June 30, 2009, the amounts provided in this subsection shall lapse.
(24) Pursuant to 42 U.S.C. Sec. 1396(a)(25), the department shall
pursue insurance claims on behalf of medicaid children served through
its in-home medically intensive child program under WAC 388-551-3000.
The department shall report to the Legislature by December 31, 2009, on
the results of its efforts to recover such claims.
(25) The department may, on a case-by-case basis and in the best
interests of the child, set payment rates for medically intensive home
care services to promote access to home care as an alternative to
hospitalization. Expenditures related to these increased payments
shall not exceed the amount the department would otherwise pay for
hospitalization for the child receiving medically intensive home care
services.
(26) $425,000 of the general fund--state appropriation for fiscal
year 2010, $425,000 of the general fund--state appropriation for fiscal
year 2011, and $1,580,000 of the general fund--federal appropriation
are provided solely to continue children's health coverage outreach and
education efforts under RCW 74.09.470. These efforts shall rely on
existing relationships and systems developed with local public health
agencies, health care providers, public schools, the women, infants,
and children program, the early childhood education and assistance
program, child care providers, newborn visiting nurses, and other
community-based organizations. The department shall seek public-private partnerships and federal funds that are or may become available
to provide on-going support for outreach and education efforts under
the federal children's health insurance program reauthorization act of
2009.
(27) The department, in conjunction with the office of financial
management, shall ((reduce outpatient and inpatient hospital rates
and)) implement a prorated inpatient payment policy. ((In determining
the level of reductions needed, the department shall include in its
calculations services paid under fee-for-service, managed care, and
certified public expenditure payment methods; but reductions shall not
apply to payments for psychiatric inpatient services or payments to
critical access hospitals.))
(28) The department will pursue a competitive procurement process
for antihemophilic products, emphasizing evidence-based medicine and
protection of patient access without significant disruption in
treatment.
(29) The department will pursue several strategies towards reducing
pharmacy expenditures including but not limited to increasing generic
prescription drug utilization by 20 percentage points and promoting
increased utilization of the existing mail-order pharmacy program.
(30) The department shall reduce reimbursement for over-the-counter
medications while maintaining reimbursement for those over-the-counter
medications that can replace more costly prescription medications.
(31) The department shall seek public-private partnerships and
federal funds that are or may become available to implement health
information technology projects under the federal American recovery and
reinvestment act of 2009.
(32) The department shall target funding for maternity support
services towards pregnant women with factors that lead to higher rates
of poor birth outcomes, including hypertension, a preterm or low birth
weight birth in the most recent previous birth, a cognitive deficit or
developmental disability, substance abuse, severe mental illness,
unhealthy weight or failure to gain weight, tobacco use, or African
American or Native American race.
(33) The department shall direct graduate medical education funds
to programs that focus on primary care training.
(34) $79,000 of the general fund--state appropriation for fiscal
year 2010 and $53,000 of the general fund--federal appropriation are
provided solely to implement Substitute House Bill No. 1845 (medical
support obligations).
(35) $63,000 of the general fund--state appropriation for fiscal
year 2010, $583,000 of the general fund--state appropriation for fiscal
year 2011, and $864,000 of the general fund--federal appropriation are
provided solely to implement Engrossed House Bill No. 2194
(extraordinary medical placement for offenders). The department shall
work in partnership with the department of corrections to identify
services and find placements for offenders who are released through the
extraordinary medical placement program. The department shall
collaborate with the department of corrections to identify and track
cost savings to the department of corrections, including medical cost
savings, and to identify and track expenditures incurred by the aging
and disability services program for community services and by the
medical assistance program for medical expenses. A joint report
regarding the identified savings and expenditures shall be provided to
the office of financial management and the appropriate fiscal
committees of the legislature by November 30, 2010. If this bill is
not enacted by June 30, 2009, the amounts provided in this subsection
shall lapse.
(36) Sufficient amounts are provided in this section to provide
full benefit dual eligible beneficiaries with medicare part D
prescription drug copayment coverage in accordance with RCW 74.09.520.
Sec. 20 RCW 43.84.092 and 2009 c 479 s 31, 2009 c 472 s 5, and
2009 c 451 s 8 are each reenacted and amended to read as follows:
(1) All earnings of investments of surplus balances in the state
treasury shall be deposited to the treasury income account, which
account is hereby established in the state treasury.
(2) The treasury income account shall be utilized to pay or receive
funds associated with federal programs as required by the federal cash
management improvement act of 1990. The treasury income account is
subject in all respects to chapter 43.88 RCW, but no appropriation is
required for refunds or allocations of interest earnings required by
the cash management improvement act. Refunds of interest to the
federal treasury required under the cash management improvement act
fall under RCW 43.88.180 and shall not require appropriation. The
office of financial management shall determine the amounts due to or
from the federal government pursuant to the cash management improvement
act. The office of financial management may direct transfers of funds
between accounts as deemed necessary to implement the provisions of the
cash management improvement act, and this subsection. Refunds or
allocations shall occur prior to the distributions of earnings set
forth in subsection (4) of this section.
(3) Except for the provisions of RCW 43.84.160, the treasury income
account may be utilized for the payment of purchased banking services
on behalf of treasury funds including, but not limited to, depository,
safekeeping, and disbursement functions for the state treasury and
affected state agencies. The treasury income account is subject in all
respects to chapter 43.88 RCW, but no appropriation is required for
payments to financial institutions. Payments shall occur prior to
distribution of earnings set forth in subsection (4) of this section.
(4) Monthly, the state treasurer shall distribute the earnings
credited to the treasury income account. The state treasurer shall
credit the general fund with all the earnings credited to the treasury
income account except:
The following accounts and funds shall receive their proportionate
share of earnings based upon each account's and fund's average daily
balance for the period: The aeronautics account, the aircraft search
and rescue account, the budget stabilization account, the capitol
building construction account, the Cedar River channel construction and
operation account, the Central Washington University capital projects
account, the charitable, educational, penal and reformatory
institutions account, the cleanup settlement account, the Columbia
river basin water supply development account, the common school
construction fund, the county arterial preservation account, the county
criminal justice assistance account, the county sales and use tax
equalization account, the data processing building construction
account, the deferred compensation administrative account, the deferred
compensation principal account, the department of licensing services
account, the department of retirement systems expense account, the
developmental disabilities community trust account, the drinking water
assistance account, the drinking water assistance administrative
account, the drinking water assistance repayment account, the Eastern
Washington University capital projects account, the education
construction fund, the education legacy trust account, the election
account, the energy freedom account, the energy recovery act account,
the essential rail assistance account, The Evergreen State College
capital projects account, the federal forest revolving account, the
ferry bond retirement fund, the freight congestion relief account, the
freight mobility investment account, the freight mobility multimodal
account, the grade crossing protective fund, the public health services
account, the health system capacity account, the personal health
services account, the high capacity transportation account, the state
higher education construction account, the higher education
construction account, the highway bond retirement fund, the highway
infrastructure account, the highway safety account, the high occupancy
toll lanes operations account, the hospital safety net assessment fund,
the industrial insurance premium refund account, the judges' retirement
account, the judicial retirement administrative account, the judicial
retirement principal account, the local leasehold excise tax account,
the local real estate excise tax account, the local sales and use tax
account, the medical aid account, the mobile home park relocation fund,
the motor vehicle fund, the motorcycle safety education account, the
multimodal transportation account, the municipal criminal justice
assistance account, the municipal sales and use tax equalization
account, the natural resources deposit account, the oyster reserve land
account, the pension funding stabilization account, the perpetual
surveillance and maintenance account, the public employees' retirement
system plan 1 account, the public employees' retirement system combined
plan 2 and plan 3 account, the public facilities construction loan
revolving account beginning July 1, 2004, the public health
supplemental account, the public transportation systems account, the
public works assistance account, the Puget Sound capital construction
account, the Puget Sound ferry operations account, the Puyallup tribal
settlement account, the real estate appraiser commission account, the
recreational vehicle account, the regional mobility grant program
account, the resource management cost account, the rural arterial trust
account, the rural Washington loan fund, the site closure account, the
small city pavement and sidewalk account, the special category C
account, the special wildlife account, the state employees' insurance
account, the state employees' insurance reserve account, the state
investment board expense account, the state investment board commingled
trust fund accounts, the state patrol highway account, the state route
number 520 corridor account, the supplemental pension account, the
Tacoma Narrows toll bridge account, the teachers' retirement system
plan 1 account, the teachers' retirement system combined plan 2 and
plan 3 account, the tobacco prevention and control account, the tobacco
settlement account, the transportation 2003 account (nickel account),
the transportation equipment fund, the transportation fund, the
transportation improvement account, the transportation improvement
board bond retirement account, the transportation infrastructure
account, the transportation partnership account, the traumatic brain
injury account, the tuition recovery trust fund, the University of
Washington bond retirement fund, the University of Washington building
account, the urban arterial trust account, the volunteer firefighters'
and reserve officers' relief and pension principal fund, the volunteer
firefighters' and reserve officers' administrative fund, the Washington
fruit express account, the Washington judicial retirement system
account, the Washington law enforcement officers' and firefighters'
system plan 1 retirement account, the Washington law enforcement
officers' and firefighters' system plan 2 retirement account, the
Washington public safety employees' plan 2 retirement account, the
Washington school employees' retirement system combined plan 2 and 3
account, the Washington state health insurance pool account, the
Washington state patrol retirement account, the Washington State
University building account, the Washington State University bond
retirement fund, the water pollution control revolving fund, and the
Western Washington University capital projects account. Earnings
derived from investing balances of the agricultural permanent fund, the
normal school permanent fund, the permanent common school fund, the
scientific permanent fund, and the state university permanent fund
shall be allocated to their respective beneficiary accounts. All
earnings to be distributed under this subsection (4) shall first be
reduced by the allocation to the state treasurer's service fund
pursuant to RCW 43.08.190.
(5) In conformance with Article II, section 37 of the state
Constitution, no treasury accounts or funds shall be allocated earnings
without the specific affirmative directive of this section.
NEW SECTION. Sec. 21
NEW SECTION. Sec. 22 Upon expiration of chapter 74.-- RCW (the
new chapter created in section 24 of this act), inpatient and
outpatient hospital reimbursement rates shall return to a rate
structure as if the four percent medicaid inpatient and outpatient rate
reductions did not occur on July 1, 2009, or as otherwise specified in
the 2013-15 biennial operating appropriations act.
NEW SECTION. Sec. 23
NEW SECTION. Sec. 24