Passed by the House April 18, 2011 Yeas 75   FRANK CHOPP ________________________________________ Speaker of the House of Representatives Passed by the Senate March 23, 2011 Yeas 45   BRAD OWEN ________________________________________ 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 HOUSE BILL 1544 as passed by the House of Representatives and the Senate on the dates hereon set forth. BARBARA BAKER ________________________________________ Chief Clerk | |
Approved April 29, 2011, 3:52 p.m. CHRISTINE GREGOIRE ________________________________________ Governor of the State of Washington | April 29, 2011 Secretary of State State of Washington |
State of Washington | 62nd Legislature | 2011 Regular Session |
Read first time 01/25/11. Referred to Committee on Health & Human Services Appropriations & Oversight.
AN ACT Relating to restricting the eligibility for the basic health plan to the basic health transition eligibles population under the medicaid waiver; reenacting and amending RCW 70.47.020; creating a new section; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 70.47.020 and 2009 c 568 s 2 are each reenacted and
amended to read as follows:
As used in this chapter:
(1) "Administrator" means the Washington basic health plan
administrator, who also holds the position of administrator of the
Washington state health care authority.
(2) "Health coverage tax credit eligible enrollee" means
individual
workers and their qualified family members who lose their jobs due to
the effects of international trade and are eligible for certain trade
adjustment assistance benefits; or are eligible for benefits under the
alternative trade adjustment assistance program; or are people who
receive benefits from the pension benefit guaranty corporation and are
at least fifty-five years old.
(3) "Health coverage tax credit program" means the program
created
by the Trade Act of 2002 (P.L. 107-210) that provides a federal tax
credit that subsidizes private health insurance coverage for displaced
workers certified to receive certain trade adjustment assistance
benefits and for individuals receiving benefits from the pension
benefit guaranty corporation.
(4) "Managed health care system" means: (a) Any health care
organization, including health care providers, insurers, health care
service contractors, health maintenance organizations, or any
combination thereof, that provides directly or by contract basic health
care services, as defined by the administrator and rendered by duly
licensed providers, to a defined patient population enrolled in the
plan and in the managed health care system; or (b) a self-funded or
self-insured method of providing insurance coverage to subsidized
enrollees provided under RCW 41.05.140 and subject to the limitations
under RCW 70.47.100(7).
(5) "Nonsubsidized enrollee" means an individual, or an
individual
plus the individual's spouse or dependent children: (a) Who is not
eligible for medicare; (b) who is not confined or residing in a
government-operated institution, unless he or she meets eligibility
criteria adopted by the administrator; (c) who is accepted for
enrollment by the administrator as provided in RCW 48.43.018, either
because the potential enrollee cannot be required to complete the
standard health questionnaire under RCW 48.43.018, or, based upon the
results of the standard health questionnaire, the potential enrollee
would not qualify for coverage under the Washington state health
insurance pool; (d) who resides in an area of the state served by a
managed health care system participating in the plan; (e) who chooses
to obtain basic health care coverage from a particular managed health
care system; and (f) who pays or on whose behalf is paid the full costs
for participation in the plan, without any subsidy from the plan.
(6) "Premium" means a periodic payment, which an individual,
their
employer or another financial sponsor makes to the plan as
consideration for enrollment in the plan as a subsidized enrollee, a
nonsubsidized enrollee, or a health coverage tax credit eligible
enrollee.
(7) "Rate" means the amount, negotiated by the administrator
withand paid to a participating managed health care system, that is based
upon the enrollment of subsidized, nonsubsidized, and health coverage
tax credit eligible enrollees in the plan and in that system.
(8) "Subsidy" means the difference between the amount of
periodic
payment the administrator makes to a managed health care system on
behalf of a subsidized enrollee plus the administrative cost to the
plan of providing the plan to that subsidized enrollee, and the amount
determined to be the subsidized enrollee's responsibility under RCW
70.47.060(2).
(9) "Subsidized enrollee" means:
(a) An individual, or an individual plus the individual's spouse
or
dependent children:
(i) Who is not eligible for medicare;
(ii) Who is not confined or residing in a government-operated
institution, unless he or she meets eligibility criteria adopted by the
administrator;
(iii) Who is not a full-time student who has received a
temporary
visa to study in the United States;
(iv) Who resides in an area of the state served by a managed
health
care system participating in the plan;
(v) Until March 1, 2011, whose gross family income at the time
of
enrollment does not exceed two hundred percent of the federal poverty
level as adjusted for family size and determined annually by the
federal department of health and human services;
(vi) Who chooses to obtain basic health care coverage from a
particular managed health care system in return for periodic payments
to the plan; ((and))
(vii) Who is not receiving medical assistance administered by
the
department of social and health services; and
(viii) After February 28, 2011, who is in the basic health
transition eligibles population under 1115 medicaid demonstration
project number 11-W-00254/10;
(b) An individual who meets the requirements in (a)(i) through
(iv), (vi), and (vii) of this subsection and who is a foster parent
licensed under chapter 74.15 RCW and whose gross family income at the
time of enrollment does not exceed three hundred percent of the federal
poverty level as adjusted for family size and determined annually by
the federal department of health and human services; and
(c) To the extent that state funds are specifically appropriated
for this purpose, with a corresponding federal match, an individual, or
an individual's spouse or dependent children, who meets the
requirements in (a)(i) through (iv), (vi), and (vii) of this subsection
and whose gross family income at the time of enrollment is more than
two hundred percent, but less than two hundred fifty-one percent, of
the federal poverty level as adjusted for family size and determined
annually by the federal department of health and human services.
(10) "Washington basic health plan" or "plan" means the system
of
enrollment and payment for basic health care services, administered by
the plan administrator through participating managed health care
systems, created by this chapter.
NEW SECTION. Sec. 2 The legislature intends to define
eligibility for the basic health plan for periods subsequent to
expiration of the 1115 medicaid demonstration project based upon
recommendations from its joint select committee on health reform
regarding whether the basic health plan should be offered as an
enrollment option for persons who qualify for federal premium subsidies
under the federal patient protection and affordable care act of 2010.
NEW SECTION. Sec. 3 This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of the
state government and its existing public institutions, and takes effect
immediately.