BILL REQ. #: S-1406.1
| State of Washington | 61st Legislature | 2009 Regular Session |
Read first time 02/09/09. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to reforming the health care system in Washington state; amending RCW 48.43.035; reenacting and amending RCW 48.43.005; adding new sections to chapter 48.43 RCW; adding a new chapter to Title 41 RCW; creating new sections; and repealing RCW 48.01.260, 48.20.025, 48.20.028, 48.20.029, 48.21.045, 48.21.047, 48.43.012, 48.43.018, 48.43.038, 48.43.041, 48.44.017, 48.44.021, 48.44.022, 48.44.023, 48.44.024, 48.46.062, 48.46.063, 48.46.064, 48.46.066, 48.46.068, 70.47.002, 70.47.005, 70.47.010, 70.47.015, 70.47.020, 70.47.030, 70.47.040, 70.47.050, 70.47.060, 70.47.070, 70.47.080, 70.47.090, 70.47.100, 70.47.110, 70.47.115, 70.47.120, 70.47.130, 70.47.140, 70.47.150, 70.47.160, 70.47.170, 70.47.200, 70.47.201, 70.47.210, 70.47.900, 70.47.901, 70.47A.010, 70.47A.020, 70.47A.030, 70.47A.040, 70.47A.050, 70.47A.060, 70.47A.070, 70.47A.080, 70.47A.090, 70.47A.100, 70.47A.110, and 70.47A.900.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 101
(1) The people of Washington have expressed their strong desire to
have increased access to a variety of health insurance products, more
affordable solutions for their businesses and families, and more
transparency in the cost of health care.
(2) Many employers are struggling to keep employees covered with
health insurance. For others, it is simply too expensive.
Additionally, employers continue to invest a significant amount of time
in the administrative side of health care coverage. The current system
requires the employer to pick a plan and removes the decision for
coverage from the employee.
(3) Estimates show that six hundred thousand Washingtonians are
uninsured. Three-quarters work or have a working family member; two-thirds are low income; and one-half are young adults ages nineteen
through thirty-four. Many are low-wage workers who are not offered, or
eligible for, employer-sponsored coverage. Some are seasonal workers
who are employed six months a year for many hours a day but without any
promise of year-long coverage. Still others work for two, even three
different employers, all of whom would be willing to pay for some of
the coverage but none who could afford the entire bill. Some employees
turn down coverage when the employee share of the premium simply
becomes too much. Even more often, an individual is without insurance
at some point during the calendar year because they are between jobs,
an ever increasing phenomenon in today's new marketplace.
(4) Lack of portability remains a constant problem as thousands of
Washington residents go uninsured every year simply because they are
temporarily between jobs or their new job does not offer an affordable
option for them. In addition, two-income earner families are punished
by the system as they are forced to choose one employer's health
insurance plan over another without a chance to collect premium
contributions from both.
(5) Access to health insurance is one of the driving factors in
improving the health of Washington citizens. Yet, we are not receiving
as much value as we should for each health care dollar spent in
Washington state. By failing to sufficiently focus our efforts on
prevention and management of chronic diseases, such as diabetes,
asthma, and heart disease, too many Washingtonians suffer from
complications of their illnesses. By failing to make health insurance
coverage affordable for low-wage workers and self-employed people,
health problems that could be treated in a primary care doctor's office
are treated in the emergency room or hospital. By failing to focus on
the most effective ways to maintain our health and treat disease,
Washingtonians have not made lifestyle changes proven to improve
health, nor do they receive the most effective care.
NEW SECTION. Sec. 102
(1) Offers more affordable coverage for employers, employees, the
self-employed, and other individuals;
(2) Makes the process of acquiring insurance far more transparent
and attractive to families;
(3) Recognizes the importance of the primary care medical home
delivery model in preventing illness and improving health outcomes;
(4) Reduces burdensome administrative costs throughout the health
care system;
(5) Provides an avenue for universal access to affordable and
quality health care coverage; and
(6) Recognizes the value in choice and flexibility as being central
to achieving maximum impact upon the uninsured population.
NEW SECTION. Sec. 201 The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Apple health" means the apple health insurance board
established in sections 202 through 204 of this act.
(2) "Apple health insurance board" and "board" means the board of
the Washington state apple health insurance board established in
sections 202 through 204 of this act.
(3) "Basic health plan" means the program administered under
chapter 70.47 RCW.
(4) "Carrier" means a carrier as defined in RCW 48.43.005.
(5) "Commissioner" means the insurance commissioner established
under RCW 48.02.010.
(6) "Eligible individual" means an individual who is eligible to
participate in apple health by reason of meeting one or more of the
following qualifications:
(a) The individual is a Washington resident, meaning that the
individual is, and continues to be, residing on a permanent and
full-time basis in a place of permanent habitation in Washington that
remains the person's principal residence and from which the person is
absent only for temporary or transitory purposes. A person who is a
full-time student attending an institution outside of Washington may
maintain his or her Washington residency;
(b) The individual is not a Washington resident but is employed, at
least twenty hours a week on a regular basis, at a Washington location
by a bona fide employer, and the individual's employer does not offer
a group health insurance plan, or the individual is not eligible to
participate in any group health insurance plan offered by the
individual's employer;
(c) The individual, whether a resident or not, is enrolled in, or
eligible to enroll in, a participating employer plan;
(d) The individual is self-employed in Washington, and if a
nonresident self-employed individual, the individual's principal place
of business is in Washington;
(e) The individual is a full-time student attending an institution
of higher education located in Washington;
(f) The individual, whether a resident or not, is a dependent of
another individual who is an eligible individual;
(g) The individual is eligible for benefits under section 210 of
the federal trade act of 2002, at 26 U.S.C. Sec. 35(c).
(7) "Eligible employer" means any individual, partnership,
corporation, business trust, or person or group of persons employing
one or more persons, and filing payroll tax information on each person.
(8) "Director" means an individual appointed by a vote of the apple
health insurance board to serve as the secretary of administration and
finance for the board.
(9) "Health plan" or "health benefit plan" means a health plan or
health benefit plan as defined in RCW 48.43.005.
(10) "Participating individual" means a person who has been
determined by apple health to be, and continues to be, an eligible
individual or an employee of a participating employer plan for purposes
of obtaining coverage through apple health.
(11) "Participating employer plan" means a group health plan, as
defined in federal law, Sec. 706 of ERISA (29 U.S.C. Sec. 1186), that
is sponsored by an employer and for which the plan sponsor has entered
into an agreement with apple health, in accordance with the provisions
of section 206 of this act, for apple health to offer and administer
health insurance benefits for enrollees in the plan.
(12) "Preexisting condition" means a preexisting condition as
defined in RCW 48.43.005.
(13) "Premium assistance payment" means a payment made to carriers
by apple health as provided in section 207 of this act.
NEW SECTION. Sec. 202 (1) There is hereby established by the
state of Washington the Washington state apple health insurance board,
referred to from now on as apple health. Apple health is created as a
body corporate and an independent instrumentality of the state of
Washington, created to serve public purposes provided for in this act,
but with legal existence separate from that of the state of Washington.
(2) Apple health is hereby recognized as a not-for-profit
corporation in accordance with the provisions of Title 24 RCW, and
shall seek recognition of the same status by the United States in
accordance with the provisions of the United States internal revenue
code, 26 U.S.C. Sec. 501(c).
(3) The limited purpose of apple health is to facilitate the
availability, portability, choice, and adoption of private health
insurance plans to eligible individuals and groups, as provided in this
chapter.
(4) Apple health shall be administered by the director and governed
by the Washington state apple health insurance board established in
this section and sections 203 and 204 of this act.
(5) The board shall appoint a director to serve as the secretary of
administration and finance for apple health and shall grant him or her
the following powers and duties:
(a) Plan, direct, coordinate, and execute administrative functions
in conformity with the policies and directives of the board;
(b) Employ professional and clerical staff as necessary;
(c) Report to the board on all operations under his or her control
and supervision;
(d) Prepare an annual budget and manage the administrative expenses
of apple health; and
(e) Undertake any other activities necessary to implement the
powers and duties set forth in this chapter.
NEW SECTION. Sec. 203 (1) The function of the Washington state
apple health insurance board is to develop and approve rules necessary
for operation of the Washington state apple health insurance board.
(2) The board shall be composed of thirteen voting members
initially appointed by the governor as follows:
(a) One health actuary;
(b) One representative of small businesses;
(c) One employee health plan benefits specialist;
(d) One representative of private sector health care consumers;
(e) A physician licensed in good standing under chapter 18.57 RCW;
(f) A health insurance broker licensed in good standing under
chapter 48.17 RCW;
(g) A representative of organized labor;
(h) A representative of business associations;
(i) A representative from the association of Washington health care
plans;
(j) The assistant secretary of the department of social and health
services, health recovery services administration, ex officio;
(k) The insurance commissioner, ex officio;
(l) The administrator of the health care authority, ex officio; and
(m) The director, ex officio.
(3) The governor shall appoint the initial members of the board to
staggered terms not to exceed four years. Members appointed or elected
thereafter shall serve two-year terms. Members of the board shall be
compensated in accordance with RCW 43.03.250 and shall be reimbursed
for their travel expenses while on official business in accordance with
RCW 43.03.050 and 43.03.060. The board shall prescribe rules for the
conduct of its business. The director shall serve as chair of the
board. Meetings of the board shall be at the call of the chair.
(4) The board may establish technical advisory committees or seek
the advice of technical experts when necessary to execute the powers
and duties included in this act.
(5) Upon the end of each corresponding term of service for such
positions as are to be prescribed, the board shall provide rules and
guidelines, such as they are necessary, for the nomination and
selection of industry representatives by their peers for the following
seven board positions:
(a) One representative of small businesses;
(b) One employee health plan specialist;
(c) One representative of health care consumers;
(d) A physician licensed in good standing under chapter 18.57 RCW;
(e) A health insurance broker licensed in good standing under
chapter 48.17 RCW;
(f) A representative of organized labor; and
(g) A representative of trade associations.
NEW SECTION. Sec. 204 The apple health board has the following
duties and powers:
(1) Establish procedures for the enrollment of eligible individuals
and groups, including:
(a) Publicizing the existence of apple health and disseminating
information on eligibility requirements and enrollment procedures for
apple health;
(b) Establishing procedures to determine each applicant's
eligibility for purchasing insurance sold in apple health, including a
standard application form for eligible individuals and groups seeking
to purchase health insurance through apple health, as well as persons
seeking a premium assistance payment. The application shall include
information necessary to determine an applicant's eligibility, previous
health insurance coverage history, and payment method;
(c) Establishing rules related to minimum participation of
employees in groups seeking to purchase health insurance through apple
health;
(d) Preparing and distributing certificate of eligibility forms and
application forms to insurance brokers and the general public; and
(e) Establishing and administering procedures for the election of
coverage by participating individuals during open enrollment periods
and outside of open enrollment periods upon the occurrence of any
qualifying event specified in the federal health insurance portability
and accountability act of 1996 or applicable state law. The procedures
shall include preparing and distributing to participating individuals:
(i) Descriptions of the coverage, benefits, limitations,
copayments, and premiums for all participating plans; and
(ii) Forms and instructions for electing coverage and arranging
payment for coverage;
(2) Establish and manage a system of collecting and transmitting to
the applicable carriers all premium payments or contributions made by
or on behalf of participating individuals, including developing
mechanisms to receive and process automatic payroll deductions for
participating individuals enrolled in employer plans;
(3) Establish a plan for operating a health insurance service
center to provide eligible individuals and employers with information
on apple health and manage enrollment, and for publicizing the
existence of apple health and apple health's eligibility requirements
and enrollment procedures;
(4) Establish other procedures for operations of apple health,
including but not limited to procedures to:
(a) Seek and receive any grant funding from the federal government,
departments or agencies of the state, and private foundations;
(b) Contract with professional service firms as may be necessary in
the board's judgment, and to fix their compensation;
(c) Contract with companies which provide third-party
administrative and billing services for insurance products;
(d) Charge and equitably apportion among participating institutions
its administrative costs and expenses incurred in the exercise of the
powers and duties granted by this chapter;
(e) Adopt bylaws for the regulation of its affairs and the conduct
of its business;
(f) Sue and be sued in its own name, plead, and be impleaded;
(g) Establish lines of credit, and establish one or more cash and
investment accounts to receive payments for services rendered and
appropriations from the state, and for all other business activity
granted by this chapter except to the extent otherwise limited by any
applicable provision of the employee retirement income security act of
1974; and
(h) Enter into interdepartmental agreements with the office of the
insurance commissioner, department of social and health services,
health care authority, and any other state agencies the board deems
necessary to implement this chapter; and
(5) Begin offering access to health benefit plans under this act on
January 1, 2011.
NEW SECTION. Sec. 205
(2) A web site will be established under the name of apple health
to provide a single portal through which eligible individuals and
organizations can apply for participation in apple health.
NEW SECTION. Sec. 206
(2) Any employer seeking to be the sponsor of a participating
employer plan shall, as a condition of participation in apple health,
enter into a binding agreement with apple health that includes the
following conditions:
(a) The sponsoring employer designates apple health to be the
plan's administrator for the employer's group health plan, and apple
health agrees to undertake the obligations required of a plan
administrator under federal law;
(b) Any individual eligible to participate in apple health by
reason of his or her eligibility for coverage under the employer's
participating employer plan, regardless of whether any such individual
would otherwise qualify as an eligible individual if not enrolled in
the participating employer plan, may elect coverage under any health
plan offered through apple health, and neither the employer nor apple
health shall limit such individual's choice of coverage from among all
the health plans offered;
(c) The employer agrees that, for the term of the agreement, the
employer will not offer to individuals eligible to participate in apple
health by reason of their eligibility for coverage under the employer's
participating employer plan any separate or competing health plan,
regardless of whether any such individuals would otherwise qualify as
eligible individuals if not enrolled in the participating employer
plan;
(d) The employer reserves the right to offer benefits supplemental
to the benefits offered through apple health, but any supplemental
benefits offered by the employer shall constitute a separate plan or
plans under federal law, for which the executive director shall not be
the plan administrator and for which neither the executive director nor
apple health shall be responsible in any manner;
(e) The employer reserves the right to determine the criteria for
eligibility and enrollment in the participating employer plan and the
terms and amounts of the employer's contributions to that plan, so long
as for the term of the agreement with apple health the employer agrees
not to alter or amend any criteria or contribution amounts at any time
other than during an annual period designated by apple health for
participating employer plans to make such changes in conjunction with
apple health's annual open enrollment period;
(f) The employer agrees to make available to apple health any of
the employer's documents, records, or information, including copies of
the employer's federal and state tax and wage reports, that the
executive director reasonably determines are necessary for apple health
to verify:
(i) That the employer is in compliance with the terms of its
agreement with apple health governing the employer's sponsorship of a
participating employer plan;
(ii) That the participating employer plan is in compliance with
applicable laws relating to employee welfare benefit plans,
particularly those relating to nondiscrimination in coverage; and
(iii) The eligibility, under the terms of the employer's plan, of
those individuals enrolled in the participating employer plan;
(g) The employer agrees to also sponsor a defined contribution
"cafeteria plan" as permitted under federal law, 26 U.S.C. Sec. 125,
for all employees eligible for coverage under the employer's
participating employer plan.
(3) Beginning January 1, 2011, the state of Washington shall enter
into an agreement with apple health to be the sponsor of a
participating employer plan on behalf of all individuals eligible for
health insurance benefits paid in whole or in part by the state of
Washington by reason of current or past employment with the state or
employment with a public institution of higher education or school
district in the state, or by reason of being a dependent of such an
individual, except for any individuals who are eligible only for
benefits consisting solely of coverage of expected benefits.
NEW SECTION. Sec. 207
(2) Beginning September 1, 2010, the administrator of the health
care authority shall accept applications for premium assistance from
eligible individuals and employees of participating employer plans who
have family income up to two hundred percent of the federal poverty
level, as determined annually by the federal department of health and
human services, on behalf of themselves, their spouses, and their
dependent children.
(3) Pursuant to subsection (2) of this section, employees of
participating employer plans who are deemed to have had affordable
benefit plan options previously available to them, when determined as
a percentage of income that is to be defined by the apple health
insurance board, shall not be eligible for the apple health community
care program. The apple health community care program shall be
reserved for individuals and employees of employer-sponsored plans who
otherwise meet income eligibility requirements and have been previously
uninsured for a period of not less than twelve months, except for basic
health enrollees described in subsection (7) of this section.
(4) The health care authority shall design and implement a schedule
of premium assistance payments that is based upon gross family income,
giving appropriate consideration to family size and the ages of all
family members and with a bias toward family units with children. The
benchmark plan for purposes of designing the premium assistance payment
schedule shall be in conformity with the average actuarial value of
benefits covered in the top three subscribed plans in the individual
insurance market as of January 1, 2009. After January 1, 2010, the
benchmark plan for purposes of the premium assistance payment schedule
shall be adjusted in conformity with the top three subscribed plans in
apple health.
The premium assistance schedule shall be applied to eligible
individuals, and to the employee premium obligation remaining after
employer premium contributions for employees of participating employer
plans, so that employees benefit financially from their employers'
contribution to the cost of their coverage through apple health. Any
surcharge included in the premium under section 210 of this act shall
be included when determining the appropriate level of premium
assistance payments.
(5) A financial sponsor may, with the prior approval of the
director, pay the premium or any other amount on behalf of an eligible
individual or employee of a participating employer plan, by arrangement
with the individual or employee and through a mechanism acceptable to
the director. The director shall establish a mechanism for receiving
premium payments from the United States internal revenue service for
eligible individuals who are eligible for benefits under section 210 of
the federal trade act of 2002, at 26 U.S.C. Sec. 35(c), and any
subsequent premium assistance programs authorized by federal law.
(6) Apple health shall remit the premium assistance in an amount
determined under subsection (4) of this section to the carrier offering
the health plan in which the eligible individual or employee of a
participating employer plan has chosen to enroll. If, however, such
individual or employee has chosen to enroll in a high deductible health
plan, any difference between the sum of premium assistance that the
individual or employee would receive and the applicable premium rate
for the high deductible health plan shall be deposited into a health
savings account for the benefit of that individual or employee.
(7) As of January 1, 2011, all basic health plan enrollees under
chapter 70.47 RCW shall transition to apple health community care. The
health care authority shall provide information and assistance
necessary to allow enrollees to successfully transition to apple health
community care, including assistance with enrolling in apple health and
choosing a health plan during the 2011 open enrollment period.
(8) This section is to be in enacted within available funding and
is not subject to any further appropriation.
NEW SECTION. Sec. 208
(2) All funds appropriated for the basic health plan under chapter
70.47 RCW shall be deposited into the apple health community care
account upon implementation of this act.
NEW SECTION. Sec. 209
(2) In cases where a membership organization enrolls in apple
health its eligible members, or the eligible members of its member
entities, the plan chosen by each individual shall pay the organization
a fee equal to the commission specified in subsection (1) of this
section. Nothing in this section shall be deemed either to require a
membership organization that enrolls persons in apple health to be
licensed by Washington as an insurance broker, or to permit such an
organization to provide any other services requiring licensure as an
insurance broker without first obtaining such license.
NEW SECTION. Sec. 210
(2) Each carrier participating in apple health shall be required to
furnish such reasonable reports as the board determines necessary to
enable the executive director to carry out his or her duties under this
chapter.
NEW SECTION. Sec. 211
NEW SECTION. Sec. 212
(1) The operation and administration of apple health, including
surveys and reports of health benefit plans available to participating
individuals and on the experience of the plans. The experience on the
plans shall include data on enrollees in apple health, the operation
and administration of apple health community care, expenses, claims
statistics, complaints data, how apple health met its goals, and other
information deemed pertinent by the apple health insurance board; and
(2) Any significant observations regarding utilization and adoption
of apple health.
NEW SECTION. Sec. 213
(1) The impact of medicaid and state children's health insurance
program enrollees participating in apple health community care, with
respect to the utilization of services and cost of health plans offered
through apple health;
(2) Whether and what distinction should be made between adult and
child enrollees;
(3) Opportunities to provide plan design flexibility through
medicaid state plan amendments;
(4) The need for a section 1115 waiver from the federal department
of health and human services for moving a sizable portion of the
medicaid and state children's health insurance program population into
a defined contribution model;
(5) A study of other states that have attempted similar reforms
involving a defined contribution model within their medicaid population
and whether any ideas should be incorporated to facilitate the move of
enrollees to apple health community care;
(6) Whether any cost savings to the state would be achieved by the
incorporation of medicaid and state children's health insurance program
enrollees to apple health community care;
(7) The effect any such move would have on the premiums of current
apple health enrollees;
(8) The capacity of participating carriers in apple health to
properly manage the care of medicaid and state children's health
insurance program enrollees as well as the capacity of current medicaid
managed care organizations to deliver coverage within apple health;
(9) The impact of expanded choice and cost sharing on medicaid
enrollees;
(10) Whether specific categories of categorically needy medicaid
and state children's health insurance program enrollees, if any, should
be excluded from participation in apple health; and
(11) If the board recommends participation of any medicaid eligible
citizens in apple health, how the composition of the apple health
insurance board should be modified to reflect their participation.
NEW SECTION. Sec. 214
Sec. 301 RCW 48.43.005 and 2008 c 145 s 20 and 2008 c 144 s 1 are
each reenacted and amended to read as follows:
Unless otherwise specifically provided, the definitions in this
section apply throughout this chapter.
(1) "Adjusted community rate" means the rating method used to
establish the premium for health plans adjusted to reflect actuarially
demonstrated differences in utilization or cost attributable to
geographic region, age, family size, and use of wellness activities.
(2) "Apple health" means the Washington state apple health
insurance board established in sections 202 through 204 of this act.
(3) "Basic health plan" means the plan described under chapter
70.47 RCW, as revised from time to time.
(((3))) (4) "Basic health plan model plan" means a health plan as
required in RCW 70.47.060(2)(e).
(((4))) (5) "Basic health plan services" means that schedule of
covered health services, including the description of how those
benefits are to be administered, that are required to be delivered to
an enrollee under the basic health plan, as revised from time to time.
(((5))) (6) "Catastrophic health plan" means:
(a) In the case of a contract, agreement, or policy covering a
single enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, one thousand seven hundred fifty dollars
and an annual out-of-pocket expense required to be paid under the plan
(other than for premiums) for covered benefits of at least three
thousand five hundred dollars, both amounts to be adjusted annually by
the insurance commissioner; and
(b) In the case of a contract, agreement, or policy covering more
than one enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, three thousand five hundred dollars and an
annual out-of-pocket expense required to be paid under the plan (other
than for premiums) for covered benefits of at least six thousand
dollars, both amounts to be adjusted annually by the insurance
commissioner; or
(c) Any health benefit plan that provides benefits for hospital
inpatient and outpatient services, professional and prescription drugs
provided in conjunction with such hospital inpatient and outpatient
services, and excludes or substantially limits outpatient physician
services and those services usually provided in an office setting.
In July 2008, and in each July thereafter, the insurance
commissioner shall adjust the minimum deductible and out-of-pocket
expense required for a plan to qualify as a catastrophic plan to
reflect the percentage change in the consumer price index for medical
care for a preceding twelve months, as determined by the United States
department of labor. The adjusted amount shall apply on the following
January 1st.
(((6))) (7) "Certification" means a determination by a review
organization that an admission, extension of stay, or other health care
service or procedure has been reviewed and, based on the information
provided, meets the clinical requirements for medical necessity,
appropriateness, level of care, or effectiveness under the auspices of
the applicable health benefit plan.
(((7))) (8) "Concurrent review" means utilization review conducted
during a patient's hospital stay or course of treatment.
(((8))) (9) "Covered person" or "enrollee" means a person covered
by a health plan including an enrollee, subscriber, policyholder,
beneficiary of a group plan, or individual covered by any other health
plan.
(((9))) (10) "Creditable coverage" means continual coverage of the
applicant under any of the following health plans, with no lapse in
coverage of more than sixty-three days immediately prior to the date of
application:
(a) A group health plan;
(b) Health insurance coverage;
(c) Part A or Part B of Title XVIII of the social security act (79
Stat. 291; 42 U.S.C. Sec. 1395c et seq. or 1395j et seq.,
respectively);
(d) Title XIX of the social security act (79 Stat. 343; 42 U.S.C.
Sec. 1396 et seq.), other than coverage consisting solely of benefits
under section 1928;
(e) 10 U.S.C. Sec. 1071 et seq.;
(f) A medical care program of the Indian health service or of a
tribal organization;
(g) A state health benefits risk pool;
(h) A health plan offered under 5 U.S.C. Sec. 8901 et seq.;
(i) The health insurance pool as established in chapter 48.41 RCW;
(j) A health benefit plan under section 5(e) of the peace corps act
(22 U.S.C. Sec. 2504(e)); or
(k) Any other qualifying coverage required by the health insurance
portability and accountability act of 1996, or regulations under that
act.
(11) "Dependent" means, at a minimum, the enrollee's legal spouse
and unmarried dependent children who qualify for coverage under the
enrollee's health benefit plan.
(((10) "Employee" has the same meaning given to the term, as of
January 1, 2008, under section 3(6) of the federal employee retirement
income security act of 1974.)) (12) "Eligible individual" means an individual, including a
sole proprietor, who is a resident of Washington state. "Eligible
individual" includes any individual who is eligible for benefits under
section 210 of the federal trade act of 2002, at 26 U.S.C. Sec. 35(c).
(11)
(13) "Emergency medical condition" means the emergent and acute
onset of a symptom or symptoms, including severe pain, that would lead
a prudent layperson acting reasonably to believe that a health
condition exists that requires immediate medical attention, if failure
to provide medical attention would result in serious impairment to
bodily functions or serious dysfunction of a bodily organ or part, or
would place the person's health in serious jeopardy.
(((12))) (14) "Emergency services" means otherwise covered health
care services medically necessary to evaluate and treat an emergency
medical condition, provided in a hospital emergency department.
(((13))) (15) "Employee" has the same meaning given to the term, as
of January 1, 2008, under section 3(6) of the federal employee
retirement income security act of 1974.
(16) "Enrollee point-of-service cost-sharing" means amounts paid to
health carriers directly providing services, health care providers, or
health care facilities by enrollees and may include copayments,
coinsurance, or deductibles.
(((14))) (17) "Grievance" means a written complaint submitted by or
on behalf of a covered person regarding: (a) Denial of payment for
medical services or nonprovision of medical services included in the
covered person's health benefit plan, or (b) service delivery issues
other than denial of payment for medical services or nonprovision of
medical services, including dissatisfaction with medical care, waiting
time for medical services, provider or staff attitude or demeanor, or
dissatisfaction with service provided by the health carrier.
(((15))) (18) "Health care facility" or "facility" means hospices
licensed under chapter 70.127 RCW, hospitals licensed under chapter
70.41 RCW, rural health care facilities as defined in RCW 70.175.020,
psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes
licensed under chapter 18.51 RCW, community mental health centers
licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment
centers licensed under chapter 70.41 RCW, ambulatory diagnostic,
treatment, or surgical facilities licensed under chapter 70.41 RCW,
drug and alcohol treatment facilities licensed under chapter 70.96A
RCW, and home health agencies licensed under chapter 70.127 RCW, and
includes such facilities if owned and operated by a political
subdivision or instrumentality of the state and such other facilities
as required by federal law and implementing regulations.
(((16))) (19) "Health care provider" or "provider" means:
(a) A person regulated under Title 18 or chapter 70.127 RCW, to
practice health or health-related services or otherwise practicing
health care services in this state consistent with state law; or
(b) An employee or agent of a person described in (a) of this
subsection, acting in the course and scope of his or her employment.
(((17))) (20) "Health care service" means that service offered or
provided by health care facilities and health care providers relating
to the prevention, cure, or treatment of illness, injury, or disease.
(((18))) (21) "Health carrier" or "carrier" means a disability
insurer regulated under chapter 48.20 or 48.21 RCW, a health care
service contractor as defined in RCW 48.44.010, or a health maintenance
organization as defined in RCW 48.46.020.
(((19))) (22) "Health plan" or "health benefit plan" means any
policy, contract, or agreement offered by a health carrier to provide,
arrange, reimburse, or pay for health care services except the
following:
(a) Long-term care insurance governed by chapter 48.84 or 48.83
RCW;
(b) Medicare supplemental health insurance governed by chapter
48.66 RCW;
(c) Coverage supplemental to the coverage provided under chapter
55, Title 10, United States Code;
(d) Limited health care services offered by limited health care
service contractors in accordance with RCW 48.44.035;
(e) Disability income;
(f) Coverage incidental to a property/casualty liability insurance
policy such as automobile personal injury protection coverage and
homeowner guest medical;
(g) Workers' compensation coverage;
(h) Accident only coverage;
(i) Specified disease or illness-triggered fixed payment insurance,
hospital confinement fixed payment insurance, or other fixed payment
insurance offered as an independent, noncoordinated benefit;
(j) Employer-sponsored self-funded health plans;
(k) Dental only and vision only coverage; and
(l) Plans deemed by the insurance commissioner to have a short-term
limited purpose or duration, or to be a student-only plan that is
guaranteed renewable while the covered person is enrolled as a regular
full-time undergraduate or graduate student at an accredited higher
education institution, after a written request for such classification
by the carrier and subsequent written approval by the insurance
commissioner.
(((20))) (23) "Material modification" means a change in the
actuarial value of the health plan as modified of more than five
percent but less than fifteen percent.
(((21))) (24) "Participating individual" means a person who has
been determined by apple health to be, and continues to be, an eligible
individual or an employee of a participating employer plan for purposes
of obtaining coverage through apple health.
(25) "Participating employer plan" means a group health plan, as
defined in federal law, Sec. 706 of the employee retirement income
security act (29 U.S.C. Sec. 1186), that is sponsored by an employer
and for which the plan sponsor has entered into an agreement with apple
health, in accordance with the provisions of section 206 of this act,
for apple health to offer and administer health insurance benefits for
enrollees in the plan.
(26) "Preexisting condition" means any medical condition, illness,
or injury that existed any time prior to the effective date of
coverage.
(((22))) (27) "Premium" means all sums charged, received, or
deposited by a health carrier as consideration for a health plan or the
continuance of a health plan. Any assessment or any "membership,"
"policy," "contract," "service," or similar fee or charge made by a
health carrier in consideration for a health plan is deemed part of the
premium. "Premium" shall not include amounts paid as enrollee point-of-service cost-sharing.
(((23))) (28) "Review organization" means a disability insurer
regulated under chapter 48.20 or 48.21 RCW, health care service
contractor as defined in RCW 48.44.010, or health maintenance
organization as defined in RCW 48.46.020, and entities affiliated with,
under contract with, or acting on behalf of a health carrier to perform
a utilization review.
(((24))) (29) "Small employer" or "small group" means any person,
firm, corporation, partnership, association, political subdivision,
sole proprietor, or self-employed individual that is actively engaged
in business that employed an average of at least two but no more than
fifty employees, during the previous calendar year and employed at
least two employees on the first day of the plan year, is not formed
primarily for purposes of buying health insurance, and in which a bona
fide employer-employee relationship exists. In determining the number
of employees, companies that are affiliated companies, or that are
eligible to file a combined tax return for purposes of taxation by this
state, shall be considered an employer. Subsequent to the issuance of
a health plan to a small employer and for the purpose of determining
eligibility, the size of a small employer shall be determined annually.
Except as otherwise specifically provided, a small employer shall
continue to be considered a small employer until the plan anniversary
following the date the small employer no longer meets the requirements
of this definition. A self-employed individual or sole proprietor who
is covered as a group of one on the day prior to June 10, 2004, shall
also be considered a "small employer" to the extent that individual or
group of one is entitled to have his or her coverage renewed as
provided in RCW 48.43.035(6).
(((25))) (30) "Utilization review" means the prospective,
concurrent, or retrospective assessment of the necessity and
appropriateness of the allocation of health care resources and services
of a provider or facility, given or proposed to be given to an enrollee
or group of enrollees.
(((26))) (31) "Wellness activity" means an explicit program of an
activity consistent with department of health guidelines, such as,
smoking cessation, injury and accident prevention, reduction of alcohol
misuse, appropriate weight reduction, exercise, automobile and
motorcycle safety, blood cholesterol reduction, and nutrition education
for the purpose of improving enrollee health status and reducing health
service costs.
NEW SECTION. Sec. 302
(2) No health benefit plan may be offered through apple health
unless the commissioner has first certified to the apple health
insurance board that:
(a) The carrier seeking to offer the plan is an admitted carrier in
Washington state and is in good standing with the office of the
insurance commissioner;
(b) The plan meets the rating specifications under section 303 of
this act, the preexisting condition provisions under RCW 48.43.015 and
48.43.025, the issue and renewal provisions of RCW 48.43.035, and the
requirements of this section; and
(c) The plan and the carrier are in compliance with all other
applicable Washington state laws.
(3) No plan shall be certified that excludes from coverage any
individual otherwise determined by apple health as meeting the
eligibility requirements for participating individuals.
(4) Each certification shall be valid for a uniform term of at
least one year, but may be made automatically renewable from term to
term in the absence of notice of either:
(a) Withdrawal by the commissioner; or
(b) Discontinuation of participation in apple health by the
carrier.
(5) Certification of a plan may be withdrawn only after notice to
the carrier and opportunity for hearing. The commissioner may,
however, decline to renew the certification of any carrier at the end
of a certification term.
(6) Each plan certified by the commissioner as eligible to be
offered through apple health shall contain a detailed description of
benefits offered including maximums, limitations, exclusions, and other
benefit limits.
(7) The commissioner shall have no discretionary authority over
benefit plan designs of products certified under this section. Any
product that meets the legal requirements of this chapter shall be
certified without delay.
(8) Apple health shall not decline or refuse to offer, or otherwise
restrict the offering to any participating individual, any plan that
has obtained, in a timely fashion in advance of the annual open season,
certification by the commissioner in accordance with the provisions of
this section.
(9) Apple health shall not impose on any participating plan or any
carrier or plan seeking to participate in apple health any terms or
conditions, including any requirements or agreements with respect to
rates or benefits, beyond, or in addition to, those terms and
conditions established and imposed by the commissioner in certifying
plans under the provisions of this section.
(10) The commissioner shall establish and administer, rules and
procedures for certifying plans to participate in apple health, in
accordance with the provisions of this section.
(11) Notwithstanding any certification requirements in subsections
(1) through (10) of this section, the apple health insurance board
shall recognize as certified, without commissioner involvement, any
regulated carrier health benefit product currently sold to individuals
or small groups in the commercial market as of January 1, 2009.
Benefit plans granted exemption from the certification process created
under this subsection must conform to eligibility, rating, and other
stipulations set forth in this chapter.
NEW SECTION. Sec. 303
(1) A carrier offering any health benefit plan through apple health
may offer and actively market a catastrophic health plan as defined in
RCW 48.43.005. Nothing in this subsection precludes a carrier from
offering, or a consumer from purchasing, other health benefit plans
that have more comprehensive benefits than those provided under this
subsection. A carrier offering a health benefit plan under this
subsection shall clearly disclose all covered benefits to consumers in
a brochure filed with the insurance commissioner.
(2) The carrier shall develop its rates based on an adjusted
community rate and may only vary the adjusted community rate for:
(a) Geographic area;
(b) Family size;
(c) Age; and
(d) Wellness activities.
(3) The adjustment for age in subsection (2)(c) of this section may
not use age brackets smaller than five-year increments, which shall
begin with age twenty and end with age sixty-five, except as provided
in subsection (8)(b) of this section. Participating individuals under
the age of twenty shall be treated as those age twenty.
(4) The carrier shall be permitted to develop separate rates for
individuals age sixty-five or older for coverage for which medicare is
the primary payer and coverage for which medicare is not the primary
payer. Both rates are subject to the requirements of this section.
(5) The permitted rates for any age group shall be no more than
three hundred seventy-five percent of the lowest rate for all age
groups.
(6) A discount for wellness activities is encouraged to reflect
actuarially justified differences in utilization or cost attributed to
such programs.
(7) Rating factors shall produce premiums for identical eligible
individuals that differ only by the amounts attributable to plan
design, with the exception of discounts for health improvement
programs.
(8)(a) Except to the extent provided otherwise in (b) of this
subsection, adjusted community rates established under this section
shall pool the medical experience of all eligible individuals
purchasing coverage through apple health. However, annual rate
adjustments for each health benefit plan offered through apple health
may vary by up to plus or minus six percentage points from the overall
adjustment of a carrier's entire pool. In addition, high deductible
health plans with health savings accounts are allowed a variance of
plus four or minus eight percentage points from the overall adjustment
of a carrier's entire pool. Any adjustment is to be approved by the
insurance commissioner, upon a showing by the carrier, certified by a
member of the American academy of actuaries that: (i) The variation is
a result of deductible leverage, benefit design, or provider network
characteristics; and (ii) for a rate renewal period, the projected
weighted average of all benefit plans will have a revenue neutral
effect on the carrier's apple health enrollees. Variations of greater
than six percentage points or minus eight percentage points for high
deductible health plans with health savings accounts, are subject to
review by the commissioner, and must be approved or denied within sixty
days of submittal. A variation that is not denied within sixty days
shall be deemed approved. The commissioner must provide to the carrier
a detailed actuarial justification for any denial within thirty days of
the denial.
(b) Carriers may treat persons under age thirty-five as a separate
experience pool for purposes of establishing rates for health plans
approved by the commissioner and available in apple health. Carriers
may treat persons under age thirty-five as one age rating band or may
elect to use age band variations such that rates for the highest age
band do not exceed one hundred fifty percent of the rates for the
lowest age band. The rates charged for persons under age thirty-five
are not subject to subsection (5) of this section.
NEW SECTION. Sec. 304
(2) Except as provided in (a) through (c) of this subsection, apple
health as established in section 202 of this act shall require any
person applying as an individual, outside of a plan permitted under
federal law, 26 U.S.C. Sec. 125, for a health benefit plan to complete
the standard health questionnaire designated under chapter 48.41 RCW.
The health questionnaire shall be kept by apple health and shall be
provided upon the request of any carrier receiving an application from
an individual, separate from any employer plan, for coverage.
Exceptions to this requirement shall include:
(a) If any person is seeking coverage in apple health and has
twenty-four months of creditable coverage as defined in RCW 48.43.005
and is applying for coverage within ninety days of disenrollment from
that creditable coverage, completion of the health questionnaire will
not be a condition of coverage.
(b) If a person is seeking a health benefit plan in apple health
due to his or her change of residence from one geographic area in
Washington state to another geographic area in Washington state where
his or her current health plan is not offered, completion of the
standard health questionnaire shall not be a condition of coverage if
application for coverage is made within ninety days of relocation.
(c) If a person is seeking a health benefit plan in apple health:
(i) Because a health care provider with whom he or she has an
established care relationship and from whom he or she has received
treatment within the past twelve months is no longer part of the
carrier's provider network under his or her existing Washington health
benefit plan; and
(ii) His or her health care provider is part of another carrier's
provider network; and
(iii) Application for a health benefit plan under that carrier's
provider network is made within ninety days of his or her provider
leaving the previous carrier's provider network; then completion of the
standard health questionnaire shall not be a condition of coverage.
(3) If, based upon the results of the standard health
questionnaire, the person qualifies for coverage under the Washington
state health insurance pool, the following shall apply:
(a) The carrier may decide not to accept the person's application
for enrollment in its apple health benefit plan; and
(b) Within fifteen business days of receipt of a completed
application, the carrier shall provide written notice of the decision
not to accept the person's application for enrollment to both the
person and the administrator of the Washington state health insurance
pool. The notice to the person shall state that the person is eligible
for health insurance provided by the Washington state health insurance
pool, and shall include information about the Washington state health
insurance pool and an application for such coverage. If the carrier
does not provide or postmark such notice within fifteen business days,
the application is deemed approved.
(4) If the person applying for a health benefit plan in apple
health:
(a) Does not qualify for coverage under the Washington state health
insurance pool based upon the results of the standard health
questionnaire;
(b) Does qualify for coverage under the Washington state health
insurance pool based upon the results of the standard health
questionnaire and the carrier elects to accept the person for
enrollment; or
(c) Is not required to complete the standard health questionnaire
designated under this chapter under subsection (1)(a) through (c) of
this section, the carrier shall accept the person for enrollment if he
or she resides within the carrier's area and provide or assure the
provision of all covered services regardless of age, sex, family
structure, ethnicity, race, health condition, geographic location,
employment status, socioeconomic status, other condition or situation,
or the provisions of RCW 49.60.174(2). The commissioner may grant a
temporary exemption from this subsection if, upon application by a
health carrier, the commissioner finds that the clinical, financial, or
administrative capacity to serve existing enrollees will be impaired if
a health carrier is required to continue enrollment of additional
eligible individuals.
(5) For a health benefit plan offered in apple health established
in section 202 of this act, every health carrier shall reduce any
preexisting condition exclusion, limitation, or waiting period in the
group health plan in accordance with the provisions of section 2701 of
the federal health insurance portability and accountability act of 1996
(42 U.S.C. Sec. 300gg).
(6) For an employer-sponsored health benefit plan offered in apple
health established in section 202 of this act:
(a) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for at least nine months, then
the carrier shall not impose a waiting period for coverage of
preexisting conditions under the new health plan.
(b) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for less than nine months,
then the carrier shall credit the time covered under the immediately
preceding health plan toward any preexisting condition waiting period
under the new health plan.
(c) For the purpose of this subsection, a preceding health plan
includes all creditable coverage as defined in RCW 48.43.005.
Sec. 305 RCW 48.43.035 and 2004 c 244 s 4 are each amended to
read as follows:
For group health benefit plans and for health benefit plans offered
through apple health established in section 202 of this act, the
following shall apply:
(1) Except as provided in section 304 of this act, all health
carriers shall accept for enrollment any state resident within the
group to whom the plan is offered and within the carrier's service area
and provide or assure the provision of all covered services regardless
of age, sex, family structure, ethnicity, race, health condition,
geographic location, employment status, socioeconomic status, other
condition or situation, or the provisions of RCW 49.60.174(2). The
insurance commissioner may grant a temporary exemption from this
subsection, if, upon application by a health carrier the commissioner
finds that the clinical, financial, or administrative capacity to serve
existing enrollees will be impaired if a health carrier is required to
continue enrollment of additional eligible individuals.
(2) Except as provided in subsection (5) of this section, all
health plans shall contain or incorporate by endorsement a guarantee of
the continuity of coverage of the plan. For the purposes of this
section, a plan is "renewed" when it is continued beyond the earliest
date upon which, at the carrier's sole option, the plan could have been
terminated for other than nonpayment of premium. The carrier may
consider the group's anniversary date as the renewal date for purposes
of complying with the provisions of this section.
(3) The guarantee of continuity of coverage required in health
plans shall not prevent a carrier from canceling or nonrenewing a
health plan for:
(a) Nonpayment of premium;
(b) Violation of published policies of the carrier approved by the
insurance commissioner;
(c) Covered persons entitled to become eligible for medicare
benefits by reason of age who fail to apply for a medicare supplement
plan or medicare cost, risk, or other plan offered by the carrier
pursuant to federal laws and regulations;
(d) Covered persons who fail to pay any deductible or copayment
amount owed to the carrier and not the provider of health care
services;
(e) Covered persons committing fraudulent acts as to the carrier;
(f) Covered persons who materially breach the health plan; or
(g) Change or implementation of federal or state laws that no
longer permit the continued offering of such coverage.
(4) The provisions of this section do not apply in the following
cases:
(a) A carrier has zero enrollment on a product;
(b) A carrier replaces a product and the replacement product is
provided to all covered persons within that class or line of business,
includes all of the services covered under the replaced product, and
does not significantly limit access to the kind of services covered
under the replaced product. The health plan may also allow
unrestricted conversion to a fully comparable product;
(c) No sooner than January 1, 2005, a carrier discontinues offering
a particular type of health benefit plan offered for groups of up to
two hundred if: (i) The carrier provides notice to each group of the
discontinuation at least ninety days prior to the date of the
discontinuation; (ii) the carrier offers to each group provided
coverage of this type the option to enroll, with regard to small
employer groups, in any other small employer group plan, or with regard
to groups of up to two hundred, in any other applicable group plan,
currently being offered by the carrier in the applicable group market;
and (iii) in exercising the option to discontinue coverage of this type
and in offering the option of coverage under (c)(ii) of this
subsection, the carrier acts uniformly without regard to any health
status-related factor of enrolled individuals or individuals who may
become eligible for this coverage;
(d) A carrier discontinues offering all health coverage in the
small group market or for groups of up to two hundred, or both markets,
in the state and discontinues coverage under all existing group health
benefit plans in the applicable market involved if: (i) The carrier
provides notice to the commissioner of its intent to discontinue
offering all such coverage in the state and its intent to discontinue
coverage under all such existing health benefit plans at least one
hundred eighty days prior to the date of the discontinuation of
coverage under all such existing health benefit plans; and (ii) the
carrier provides notice to each covered group of the intent to
discontinue the existing health benefit plan at least one hundred
eighty days prior to the date of discontinuation. In the case of
discontinuation under this subsection, the carrier may not issue any
group health coverage in this state in the applicable group market
involved for a five-year period beginning on the date of the
discontinuation of the last health benefit plan not so renewed. This
subsection (4) does not require a carrier to provide notice to the
commissioner of its intent to discontinue offering a health benefit
plan to new applicants when the carrier does not discontinue coverage
of existing enrollees under that health benefit plan; or
(e) A carrier is withdrawing from a service area or from a segment
of its service area because the carrier has demonstrated to the
insurance commissioner that the carrier's clinical, financial, or
administrative capacity to serve enrollees would be exceeded.
(5) The provisions of this section do not apply to health plans
deemed by the insurance commissioner to be unique or limited or have a
short-term purpose, after a written request for such classification by
the carrier and subsequent written approval by the insurance
commissioner.
(6) Notwithstanding any other provision of this section, the
guarantee of continuity of coverage applies to a group of one only if:
(a) The carrier continues to offer any other small employer group plan
in which the group of one was eligible to enroll on the day prior to
June 10, 2004; and (b) the person continues to qualify as a group of
one under the criteria in place on the day prior to June 10, 2004.
NEW SECTION. Sec. 306
(2) A carrier shall not issue or renew a small group health benefit
plan other than through apple health established in this act, after
January 1, 2011.
(3) Nothing in subsection (2) or (3) of this section shall have any
effect on the operation of association health plans or any other
benefit plans operated outside of the regulated individual and small
group commercial markets.
NEW SECTION. Sec. 307
NEW SECTION. Sec. 401
(a) The employee's election to, in lieu of insurance coverage, take
full personal responsibility for any and all health care-related
expenses incurred while without coverage, including but not limited to:
Preventative, emergency, and major medical services;
(b) The employee's forfeiture of any and all rights to any
consideration or compensation in lieu of their employers financial
contribution for health care;
(c) The employee's election to apply, or not apply, for coverage
through apple health; and
(d) The employee's election to be considered, or not to be
considered, for apple health community care or other publicly financed
health insurance program.
(2) Each form shall be signed by the individual to whom it
pertains.
(3) Each self-employed individual in Washington shall annually file
the same form with the commissioner.
(4) The secretary of the department of social and health services
shall annually file the same form with the commissioner on behalf of
all individuals receiving medical assistance benefits through a state-funded program, excepting such individuals as who are also covered by
Part A or Part B of Title XVIII of the social security act (79 Stat.
291; 42 U.S.C. Sec. 1395c et seq. or 1395j et seq., respectively).
(5) For purposes of this section, "health insurance coverage" does
not include any coverage consisting solely of one or more excepted
benefits.
(6) The commissioner shall prepare and distribute such forms
through electronic means.
NEW SECTION. Sec. 501
(a) Carriers already pay for half of all high-risk claims through
assessments that go toward the Washington state health insurance pool;
(b) Consumers are asked to share in that responsibility with higher
premium costs; and
(c) Because they are the most directly affected by any high-risk
transfer system, carriers are best suited to develop and come to
agreement with the commissioner on a model that would effectively
balance risk among carriers in apple health but not artificially shift
costs to average-risk consumers or the state.
(2) On a date no later than January 1, 2010, the insurance
commissioner shall convene a high-risk transfer pool task force
consisting of representatives from each insurance carrier licensed in
Washington state and certified to sell health benefit plans in apple
health as of January 1, 2010.
(3) A series of meetings shall be held among all task force members
at a location to be determined by the commissioner. The following
parameters apply:
(a) Discussion shall be limited to risk transfer solutions that
minimize or exclude any state subsidy and preserve the affordability of
insurance products for all state residents; and
(b) Such discussion shall examine the potential for leveraging
additional federal funds for lower-income pool participants.
(4) In direct consultation with the commissioner, the task force
members shall develop a high-risk transfer proposal that will best
serve apple health, its carriers, and its enrollees for transferring
high-risk claims evenly among carriers.
(5) The task force shall consider active and proposed models from
other states that function to spread high risk in the most equitable
manner possible.
(6) The task force shall complete its work on a date no later than
January 1, 2011, and shall publish a final report for public
consumption.
(7) The final report shall be submitted to the governor and the
appropriate committees of the house of representatives and senate for
expedient consideration and further action.
NEW SECTION. Sec. 601 (1) Sections 102 and 201 through 214 of
this act constitute a new chapter in Title
(2) Sections 302, 303, 304, 306, 307, and 401 of this act are each
added to chapter 48.43 RCW.
NEW SECTION. Sec. 602 Part headings and captions used in this
act are not any part of the law.
NEW SECTION. Sec. 603 The following acts or parts of acts are
each repealed:
(1) RCW 48.01.260 (Health benefit plans -- Carriers -- Clarification)
and 2000 c 79 s 40;
(2) RCW 48.20.025 (Schedule of rates for individual health benefit
plans -- Loss ratio -- Remittance of premiums -- Definitions) and 2008 c 303
s 4, 2003 c 248 s 8, 2001 c 196 s 1, & 2000 c 79 s 3;
(3) RCW 48.20.028 (Calculation of premiums -- Adjusted community
rating method -- Definitions) and 2006 c 100 s 1, 2000 c 79 s 4, 1997 c
231 s 207, & 1995 c 265 s 13;
(4) RCW 48.20.029 (Calculation of premiums -- Members of a purchasing
pool--Adjusted community rating method--Definitions) and 2006 c 100 s
2;
(5) RCW 48.21.045 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers -- Definitions)
and 2008 c 143 s 6, 2007 c 260 s 7, 2004 c 244 s 1, 1995 c 265 s 14, &
1990 c 187 s 2;
(6) RCW 48.21.047 (Requirements for plans offered to small
employers -- Definitions) and 2005 c 223 s 11 & 1995 c 265 s 22;
(7) RCW 48.43.012 (Individual health benefit plans -- Preexisting
conditions) and 2001 c 196 s 6 & 2000 c 79 s 19;
(8) RCW 48.43.018 (Requirement to complete the standard health
questionnaire -- Exemptions -- Results) and 2007 c 259 s 37, 2007 c 80 s
13, 2004 c 244 s 3, 2001 c 196 s 8, 2000 c 80 s 4, & 2000 c 79 s 21;
(9) RCW 48.43.038 (Individual health plans -- Guarantee of continuity
of coverage--Exceptions) and 2000 c 79 s 25;
(10) RCW 48.43.041 (Individual health benefit plans -- Mandatory
benefits) and 2000 c 79 s 26;
(11) RCW 48.44.017 (Schedule of rates for individual contracts--Loss ratio -- Remittance of premiums -- Definitions) and 2008 c 303 s 5,
2001 c 196 s 11, & 2000 c 79 s 29;
(12) RCW 48.44.021 (Calculation of premiums -- Members of a
purchasing pool -- Adjusted community rating method -- Definitions) and
2006 c 100 s 4;
(13) RCW 48.44.022 (Calculation of premiums -- Adjusted community
rate -- Definitions) and 2006 c 100 s 3, 2004 c 244 s 6, 2000 c 79 s 30,
1997 c 231 s 208, & 1995 c 265 s 15;
(14) RCW 48.44.023 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers) and 2008 c 143
s 7, 2007 c 260 s 8, 2004 c 244 s 7, 1995 c 265 s 16, & 1990 c 187 s 3;
(15) RCW 48.44.024 (Requirements for plans offered to small
employers -- Definitions) and 2003 c 248 s 15 & 1995 c 265 s 23;
(16) RCW 48.46.062 (Schedule of rates for individual agreements--Loss ratio -- Remittance of premiums -- Definitions) and 2008 c 303 s 6,
2001 c 196 s 12, & 2000 c 79 s 32;
(17) RCW 48.46.063 (Calculation of premiums--Members of a
purchasing pool -- Adjusted community rating method -- Definitions) and
2006 c 100 s 6;
(18) RCW 48.46.064 (Calculation of premiums -- Adjusted community
rate -- Definitions) and 2006 c 100 s 5, 2004 c 244 s 8, 2000 c 79 s 33,
1997 c 231 s 209, & 1995 c 265 s 17;
(19) RCW 48.46.066 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers) and 2008 c 143
s 8, 2007 c 260 s 9, 2004 c 244 s 9, 1995 c 265 s 18, & 1990 c 187 s 4;
(20) RCW 48.46.068 (Requirements for plans offered to small
employers -- Definitions) and 2003 c 248 s 16 & 1995 c 265 s 24;
(21) RCW 70.47.002 (Intent -- 2002 c 2 (Initiative Measure No. 773))
and 2002 c 2 s 1;
(22) RCW 70.47.005 (Transfer power, duties, and functions to
Washington state health care authority) and 1993 c 492 s 201;
(23) RCW 70.47.010 (Legislative findings -- Purpose -- Administrator
and department of social and health services to coordinate eligibility)
and 2000 c 79 s 42, 1993 c 492 s 208, & 1987 1st ex.s. c 5 s 3;
(24) RCW 70.47.015 (Expanded enrollment -- Findings -- Intent -- Enrollee
premium share -- Expedited application and enrollment process -- Commission
for insurance producers) and 2008 c 217 s 99, 1997 c 337 s 1, & 1995 c
265 s 1;
(25) RCW 70.47.020 (Definitions) and 2007 c 259 s 35, 2005 c 188 s
2, 2004 c 192 s 1, 2000 c 79 s 43, 1997 c 335 s 1, & 1997 c 245 s 5;
(26) RCW 70.47.030 (Basic health plan trust account -- Basic health
plan subscription account) and 2004 c 192 s 2, 1995 2nd sp.s. c 18 s
913, 1993 c 492 s 210, & 1992 c 232 s 907;
(27) RCW 70.47.040 (Basic health plan -- Health care authority head
to be administrator -- Joint operations -- Technical advisory committee)
and 1993 c 492 s 211 & 1987 1st ex.s. c 5 s 6;
(28) RCW 70.47.050 (Rules) and 1987 1st ex.s. c 5 s 7;
(29) RCW 70.47.060 (Powers and duties of administrator -- Schedule of
services -- Premiums, copayments, subsidies -- Enrollment) and 2007 c 259
s 36, 2006 c 343 s 9, 2004 c 192 s 3, 2001 c 196 s 13, & 2000 c 79 s
34;
(30) RCW 70.47.070 (Benefits from other coverages not reduced) and
1987 1st ex.s. c 5 s 9;
(31) RCW 70.47.080 (Enrollment of applicants -- Participation
limitations) and 1993 c 492 s 213 & 1987 1st ex.s. c 5 s 10;
(32) RCW 70.47.090 (Removal of enrollees) and 1987 1st ex.s. c 5 s
11;
(33) RCW 70.47.100 (Participation by a managed health care system)
and 2004 c 192 s 4, 2000 c 79 s 35, & 1987 1st ex.s. c 5 s 12;
(34) RCW 70.47.110 (Enrollment of medical assistance recipients)
and 1991 sp.s. c 4 s 3 & 1987 1st ex.s. c 5 s 13;
(35) RCW 70.47.115 (Enrollment of persons in timber impact areas)
and 1992 c 21 s 7 & 1991 c 315 s 22;
(36) RCW 70.47.120 (Administrator -- Contracts for services) and 1997
c 337 s 7 & 1987 1st ex.s. c 5 s 14;
(37) RCW 70.47.130 (Exemption from insurance code) and 2004 c 115
s 2, 2000 c 5 s 21, 1997 c 337 s 8, 1994 c 309 s 6, & 1987 1st ex.s. c
5 s 15;
(38) RCW 70.47.140 (Reservation of legislative power) and 1987 1st
ex.s. c 5 s 2;
(39) RCW 70.47.150 (Confidentiality) and 2005 c 274 s 336 & 1990 c
54 s 1;
(40) RCW 70.47.160 (Right of individuals to receive services -- Right
of providers, carriers, and facilities to refuse to participate in or
pay for services for reason of conscience or religion -- Requirements)
and 1995 c 266 s 3;
(41) RCW 70.47.170 (Annual reporting requirement) and 2006 c 264 s
1;
(42) RCW 70.47.200 (Mental health services -- Definition -- Coverage
required, when) and 2005 c 6 s 6;
(43) RCW 70.47.201 (Mental health services -- Rules) and 2005 c 6 s
11;
(44) RCW 70.47.210 (Prostate cancer screening) and 2006 c 367 s 7;
(45) RCW 70.47.900 (Short title) and 1987 1st ex.s. c 5 s 1;
(46) RCW 70.47.901 (Severability -- 1987 1st ex.s. c 5) and 1987 1st
ex.s. c 5 s 26;
(47) RCW 70.47A.010 (Finding -- Intent) and 2007 c 260 s 1 & 2006 c
255 s 1;
(48) RCW 70.47A.020 (Definitions) and 2008 c 143 s 1, 2007 c 260 s
2, & 2006 c 255 s 2;
(49) RCW 70.47A.030 (Health insurance partnership established--Administrator duties) and 2008 c 143 s 2, 2007 c 259 s 58, & 2006 c 255
s 3;
(50) RCW 70.47A.040 (Applications for premium subsidies) and 2008
c 143 s 3, 2007 c 260 s 6, & 2006 c 255 s 4;
(51) RCW 70.47A.050 (Enrollment to remain within appropriation) and
2007 c 260 s 12 & 2006 c 255 s 5;
(52) RCW 70.47A.060 (Rules) and 2007 c 260 s 13 & 2006 c 255 s 6;
(53) RCW 70.47A.070 (Reports) and 2008 c 143 s 4 & 2006 c 255 s 7;
(54) RCW 70.47A.080 (Health insurance partnership account) and 2007
c 260 s 14 & 2006 c 255 s 8;
(55) RCW 70.47A.090 (State children's health insurance program--Federal waiver request) and 2006 c 255 s 9;
(56) RCW 70.47A.100 (Health insurance partnership board) and 2007
c 260 s 4;
(57) RCW 70.47A.110 (Health insurance partnership board -- Duties)
and 2008 c 143 s 5 & 2007 c 260 s 5; and
(58) RCW 70.47A.900 (Captions not law -- 2006 c 255) and 2006 c 255
s 11.